Per Diem Medical Director Orthopedic Surgery or Neurosurgery - Remote
Hybrid
Minneapolis, MN, United States(flexible)
Minneapolis, MN, United States(flexible)
Posted 14 days ago
Job Details
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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. The Per Diem Medical Director provides leadership, organization, and direction for the claims review program. They are responsible for the overall quality, effectiveness and coordination of the medical services provided through Optum. The Medical Director will participate in all aspects of claim review services. In addition, the Medical Director may also be asked to assist in the direction and oversight in the development and implementation of policies and procedures and clinical criteria for all medical programs and services. S/he will serve as a liaison between Optum, physicians, and other medical service providers in selected situations primarily related to medical claim reviews. You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities:
- Reviews surgical and other professional claims for correct coding using clinical record
- Participation in Training regarding URAC, NCQA, Regulatory Compliance, Confidentiality, Conflict of Interest, HIPAA, and department specific training as applicable
- Participates in periodic clinical conferences / calls and in ongoing internal performance consistency reviews
- Composes, if needed, patient situation specific, clinical summaries and rationales
- Supports compliance with regulatory agency standards and requirements (e.g., CMS, NCQA, URAC, state / federal and third party payers)
- Provide Clinical support for staff that conduct initial reviews
- May be asked to support other areas based on business need
- Per Diem employees are hired to work on a periodic or intermittent basis
- Current, active, and fully unrestricted medical license
- Board certification in Orthopedic surgery or Neurosurgery
- 5+ years clinical experience post residency
- Technical proficiency in computer software and systems; specifically Microsoft Office
- Private home office and access to high-speed Internet
- Sub-Specialty training and experience in Spine, Hand, Foot and Ankle or Sports Medicine
- Experience in managed care
- Experience with integration of clinical and financial data, development of utilization and performance reporting tools, and communication of performance data to physicians and other health care providers
- Proven leadership skills in working with other physicians, knowledge of the overall medical community and the local / regional managed care environments
Learn more about UnitedHealth Group
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