CCAT Medical Director - Telecommute

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)

This Medical Director role in the Clinical & Coding Advisory Team (CCAT) is a rare opportunity to work directly within Optum Payer Operations. As a member of CCAT, you will play a vital role in helping stop fraud, waste, abuse, and error and help healthcare work better every day.

The purpose of this job is to help people live their lives to the fullest by providing clinical leadership and expertise for the clinical investigation teams, including involvement in clinical reviews, provider education, high level appeals, development of clinical resources, and operations improvements.

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

Primary Responsibilities:

• Provide expert clinical and strategic leadership for operational teams
• Collaborate with clinical operations teams on complex or difficult cases
• Apply clinical knowledge in the interpretation of medical policy, clinical resources, and benefit document language in the review of professional and facility pre-pay and post-pay clinical reviews
• Collaborate with and educate network and non-network providers on cases and clinical coding situations in pursuit of accurate billing practices
• Actively participate in regular meetings and projects focused on clinical decision-making, clinical resources, analytics, savings, and staff training
• Participate in development of medical policy, clinical resources, and guidelines utilized in the review of professional and facility pre-pay and post-pay clinical reviews
• Other duties and goals assigned by the Sr. Medical Director

Critical Success Factors:

• Ability to effective lead, manage and deliver in a fast pace, ever changing environment
• Solid understanding of Fraud, Waste, Abuse, and Error methodology
• Ability to foster communications, robust collaboration, and solid partnerships among providers, clients, leaders, and clinical teams
• Solid problem-solving, negotiation and persuasion skills

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:

• Current, active, and fully non-restricted licensed Medical Doctor
• Medical Board Certification
• 3+ years of clinical practice experience
• 2+ years of Insurance Medicine experience
• CPT/HCPCS/ICD-9/ICD-10 coding experience with a thorough knowledge of health insurance business, including knowledge of industry terminology and regulatory guidelines
• Familiarity with current medical issues and practices
• Experience in Fraud/Waste/Abuse/Error

Preferred Qualifications:

• Coding Certification thru AHIMA (CCS, CDIS, RHIA, RHIT) or AAPC (CIC)
• 2+ years’ experience in leading clinical operations within a health plan/or managed care environment to include client facing experience
• Experience in facility (DRG and Clinical Validation Audit) reviews
• Experience with Encoder and Grouper Software (3M)
• Knowledge of federal (e.g., CMS) and state laws and regulations

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)

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

Colorado, Connecticut or Nevada Residents Only: The Salary range for Colorado, Connecticut and Nevada residents is $254,600 to $295,200. 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

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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