Optum is looking for Utilization Management Review Physician to join our Utilization Management team. We are aiming to find a person with very strong persuasive communication skills, a strong grasp of the big picture in healthcare economics as well as capacity to learn our complex networks.
- Responsible for timely review of requests for service; performing pre-service authorization review and post- service / claims review and make determination based on medical necessity and appropriateness of care within established guidelines.
- Adhere to regulatory, health plan, and clinical guidelines for denials.
- Identify utilization trends and work with Regional leadership team when interventions are indicated.
- Work collaboratively with UM Review Physicians and Care Management team.
- Attend monthly Utilization Management meeting for region.
- Position will cover designated region; travel to multiple sites and regional office based in Arcadia.
- Unrestricted CA Medical License
- Current CA DEA certificate required prior to start date
- Current Board Certification
- Minimum five years clinical experience
- Minimum 2 - 3 years’ experience in medical group, health plan setting; prior authorization review experience required
- Excellent working knowledge of CMS regulations
- Knowledge of health plan and regulatory requirements
- Proficient with CPT and ICD-10 codes
- Excellent oral and written communication skills
- Ability to work independently in team oriented environment
- Computer proficient
- Live inside service area full-time
If you’re looking to join a physician-led community that is making a difference in healthcare, Optum is the place for you. We provide our clinicians an excellent benefit package which includes leadership pathways, CME reimbursement, paid license renewals and many other benefits, charitable sponsorships, and volunteer opportunities. Our initial on-line application process will take you less than two minutes to complete!
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. Optum brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Here you’ll find incredible ideas in one incredible company and a singular opportunity to do your life's best work.(SM)
Diversity creates a healthier atmosphere: Optum and its affiliated medical practices are Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Optum and its affiliated medical practices is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.