Medical Director - Prior Authorization - Remote

Overview

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities.

Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

Looking for a chance to drive measurable and meaningful improvement in the use of evidence-based medicine, patient safety, practice variation and affordability? You can make a difference at United Health Group and our family of businesses in serving our Medicare, Medicaid and commercial members and plan sponsors. Be part of changing the way health care is delivered while working with a Fortune 4 industry leader.

This position will support the growing Prior Auth program which covers the New Mexico, Utah, Nevada, and Arizona Markets. The scope of this role will include Prior Authorization for Medicare Advantage members focusing on high value procedures such as Myocardial SPECT, PET scans, DME/Home Ventilator, Genetic Testing, and many more. Additionally, the team handles UM functions for the Arizona and New Mexico markets.

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

• Work to improve quality and promote evidence-based medicine
• Prior authorization, utilization management and claims review cases for patients
• Provide information on quality and efficiency to doctors, patients and customers to inform care choices and drive improvement
• Support initiatives that enhance quality throughout our national network
• Ensure the right service is provided at the right time for each member
• Work with medical director teams focusing on inpatient care management, clinical coverage review, member appeals clinical review, medical claim review and provider appeals clinical review
• Success in this technology-heavy role requires exceptional leadership skills, the knowledge and confidence to make autonomous decisions and an ability to thrive in a production-driven setting

• MD or DO degree
• Active, unrestricted physician state license
• Current board certification in ABMS or AOA specialty
• 5+ years of clinical practice experience post residency
• Proven solid understanding of and concurrence with evidence-based medicine (EBM) and managed care principles

• Hands‑on utilization and/or quality management experience
• Prior Authorization experience
• Project management or active project participation experience
• Substantial experience in using electronic clinical systems
• Licensure in New Mexico, Utah, Nevada, or Arizona (or willing and able to obtain)

All employees working remotely will be required to adhere to United Health Group’s Telecommuter Policy.