Optum Home & Community Care, part of the UnitedHealth Group family of businesses, is creating something new in health care. We are uniting industry-leading solutions to build an integrated care model that holistically addresses an individual’s physical, mental and social needs - helping patients access and navigate care anytime and anywhere.
As a team member of our naviHealth product, we help change the way health care is delivered from hospital to home supporting patients transitioning across care settings. This life-changing work helps give older adults more days at home.
We’re connecting care to create a seamless health journey for patients across care settings. Join us to start
Caring. Connecting. Growing together.
Why naviHealth?
At naviHealth, our mission is to work with extraordinarily talented people who are committed to making a positive and powerful impact on society by transforming health care. naviHealth is the result of almost two decades of dedicated visionary leaders and innovative organizations challenging the status quo for care transition solutions. We do health care differently and we are changing health care one patient at a time. Moreover, have a genuine passion and energy to grow within an aggressive and fun environment, using the latest technologies in alignment with the company’s technical vision and strategy
You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. We are currently looking for Medical Directors that can work daytime in any of the continental time zones in the US.
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 Care Transitions’ services
- Respond to clinical inquiries and serve as a non-promotional medical contact point for various healthcare providers
- Represent Care Transitions 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 Care Transitions’ 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 Care Transitions’ 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, preferably in inpatient or post-acute setting
Preferred Qualifications
- Licensure in multiple states
- Willing to obtain additional state licenses, with Optum’s support
- Understanding of population-based medicine, preferably with knowledge of CMS criteria for post-acute care
- Demonstrated ability to work within a team environment while completing multiple tasks simultaneously
- Demonstrated ability to complete assignments with reasonable oversight, direction, and supervision
- Demonstrated ability to positively interact with other clinicians, management, and all levels of medical and non-medical professionals
- Demonstrated competence in use of electronic health records as well as associated technology and applications
- Proven excellent organizational, analytical, verbal and written communication skills
- Proven solid interpersonal skills with ability to communicate and build positive relationships with colleagues
- Proven highest level of ethics and integrity
- Proven highly motivated, flexible and adaptable to working in a fast-paced, dynamic environment
- All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
California, Colorado, Connecticut, Hawaii, Maryland, Nevada, New Jersey, New York, Rhode Island, Washington, Washington, D.C. Residents Only: The salary range for this role is $286,104 to $397,743 annually. Salary Range is defined as total cash compensation at target. The actual 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 local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.
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.
