***15,000.00*** SIGN ON BONUS

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

If you are able to work in the PST Zone, you will have the flexibility to telecommute* from anywhere as you take on some tough challenges. This position is ideal for anyone living in Los Angeles, San Francisco, San Diego, Sacramento, San Jose, Irvine or any other CA city.

Primary Responsibilities:

• Responsible for daily UM reviews (authorizations and adverse determination reviews) and coverage reviews based on individual member plan benefits, national, state, CMS and proprietary coverage review policies and render determinations
• Conduct peer to peer conversations for the clinical case reviews and coverage reviews, as needed to review and discuss and share tools, information, and evidence-based guidelines, opportunities to close clinical quality / service gaps, and care plan changes that can impact health care expenses as they relate to cost-effective healthcare delivery and quality of care
• Participate in telephonic outreach for collaboration with treating providers
• Communicate effectively with network and non-network providers to ensure the successful administering of John Muir Health (JMH) services
• Is grounded in the use and application of evidence-based medicine (EBM), InterQual, MCG and EPIC
• Provide daily utilization oversight and external communication with network physicians and hospitals
• Maintain proficiency in all required software and platforms
• Effectively engage and articulate the Optum and UHC value story to our external constituents such as physicians and our customers.
• Adhere to medical director performance metrics and evaluations
• Knowledge of admission, readmission data, and overall medical expense that would drive changes in focus at the case level
• Alert Medical Directors to provider issues of compliance with plan protocols compliance, with health plan protocols, over utilization, quality of care issues, and lack of adherence to EBM guidelines
• Support quality reviews, inter-rater reliability sessions, regulatory requirements, and accreditation and certification efforts. Participation in Training regarding URAC, NCQA, Regulatory Compliance, Confidentiality, Conflict of Interest, HIPAA, and department specific training as applicable
• 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:

• MD or DO with an active, unrestricted medical license in the state of California
• Current Board Certification in an ABMS or AOBMS specialty
• 3+ years of clinical practice experience post residency
• 2+ years of managed care experience with UM level of care and length of stay determinations and Clinical Coverage Review (preservice prior authorizations)
• Proficiency with InterQual, MCG criteria and EPIC
• Proficiency with Microsoft Office applications
• Proven written and oral communication skills with customer facing experience
• Proven project management skills
• Proven data analysis and interpretation skills; Ability to focus on key metrics
• Must be willing to work PST business hours however not need to reside in that time zone

Preferred Qualifications:

• Board certification in Internal Medicine, Family Medicine, or Med / Peds

UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.

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)

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

Colorado Residents Only: The salary range for Colorado residents is $254,600 to $295,200. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.

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.

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