naviHealth, part of Optum and the UnitedHealth Group family of businesses, combines the talents of our dedicated staff and leading-edge technology to deliver compassionate care to seniors nationwide. With millions of lives touched, we are innovating the way health care is delivered from hospital to home so seniors can lead more fulfilling lives. A career with us means making an impact in the lives of those we serve, including vulnerable populations who benefit from care that is more efficient, more effective and more human. Our environment empowers our team members to elevate our interactions with each other and the experiences we deliver to our patients, giving them more days at home. Join our team, it’s your chance to improve the lives of millions while doing your life’s best work.(sm)

The Medical Director will partner with cross-functional teams and senior leaders to ensure that naviHealth leads the industry in innovative health management strategies and is considered an expert in the field of post-acute care. The role is a physician leader with a proven track record of innovation, achievement of measurable goals, and exceptional clinical competencies. They take a proactive approach to the marketplace and are responsible for continuously reshaping naviHealth’s corporate-wide strategies.

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Provide daily utilization oversight and external communication with network physicians and hospitals
• Daily UM reviews - authorizations and denial reviews
• Conduct peer to peer conversations for the clinical case reviews, as needed
• Conduct provider telephonic review and discussion and share tools, information, and guidelines as they relate to cost-effective healthcare delivery and quality of care
• Communicate effectively with network and non-network providers to ensure the successful administering of naviHealth’s services
• Respond to clinical inquiries and serve as a non-promotional medical contact point for various healthcare providers
• Represent naviHealth on appropriate external levels identifying, engaging and establishing/maintaining relationships with other thought leaders
• Collaborate with Client Services Team to ensure a coordinated approach to delivery system providers
• Contribute to the development of action plans and programs to implement strategic initiatives and tactics to address areas of concern and monitor progress toward goals
• Interact, communicate, and collaborate with network and community physicians, hospital leaders and other vendors regarding care and services for enrollees
• Provide leadership and guidance to maximize cost management through close coordination with all network and provider contracting
• Regularly meet with naviHealth’s leadership to review care coordination issues, develop collaborative intervention plans, and share ideas about network management issues
• Provide input on local needs for Analytics Team and Client Services Team to better enhance naviHealth’s products and services
• Ensure appropriate management/resolution of local queries regarding patient case management either by responding directly or routing these inquiries to the appropriate SME
• Participate on the Medical Advisory Board
• Providing intermittent, scheduled weekend and evening coverage
• Perform other duties and responsibilities as required, assigned, or requested

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• Board certification as an MD, DO, MBBS with a current unrestricted license to practice and maintain necessary credentials to retain the position
• Current, unrestricted medical license and the ability to obtain licensure in multiple states
• 3+ years of post-residency patient care, preferrably in inpatient or post-acute setting

Preferred Qualifications:

• Licensure in multiple states
• Willing to obtain additional state licenses, with naviHealth’s support
• Understanding of population-based medicine, preferrably with knowledge of CMS criteria for post-acute care
• Excellent organizational, analytical, verbal and written communication skills
• Ability to work within a team environment while completing multiple tasks simultaneously
• Ability to complete assignments with reasonable oversight, direction, and supervision
• Highly motivated, flexible and adaptable to working in a fast-paced, dynamic environment
• Solid interpersonal skills with ability to communicate and build positive relationships with colleagues
• Able to positively interact with other clinicians, management, and all levels of medical and non-medical professionals
• Highest level of ethics and integrity
• Demonstrated competence in use of electronic health records as well as associated technology and applications
• Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation

Work Conditions and Physical Requirements:

• Using phone and computer in a full day of authorization reviews, peer to peer discussions, interaction with colleagues, team members, and management
• Ability to establish a home office workspace
• Ability to manipulate laptop computer (or similar hardware)
• Ability to view screen and enter data into a laptop computer (or similar hardware) within a standard period of time
• Ability to communicate including use of cellular phone or comparable communication device
• Ability to remain stationary for extended time periods (1 - 2 hours)

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, 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. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado / Connecticut / Nevada residents is $254,600 to $295,200. The range and pay mix of base and bonus is variable based upon experience and metric achievement. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer 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.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.