Focus Claims Review - Medical Director, Orthopedic Surgery - Per Diem - Remote
Company: UnitedHealth Group
Location: Alexandria
Posted on: September 14, 2023
Job Description:
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.--As part of the Optum
Enterprise Clinical Services, Focus Claims Review team, the 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 FCR. The Medical Director will participate in--all
aspects of claim review services including provider telephonic
discussions and provider appeals.-- 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 FCR, 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
- Discusses cases and clinical coding situations with treating
providers telephonically during scheduled hours
- Participates in periodic clinical conferences / calls and in
ongoing internal performance consistency reviews
- Composes, if needed, patient situation specific, clinical
summaries and rationales for medical necessity decisions
- Is available for rare, periodic weekend and holiday as needed
telephonic and remote computer expedited clinical decisions
- Supports compliance with regulatory agency standards and
requirements (e.g., CMS, NCQA, URAC, state / federal and third
party payers)
- Ability to assist in marketing presentations to clients and
ongoing relationship management activities with existing clients if
requested to do so
- Provide Clinical support for staff that conduct initial
reviews
- Good understanding of professional performance measurement and
related possible discussions/interventions with selected
providers/groups/organizations
- May be asked to support other areas based on business need
--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 unrestricted Medical license
- Board certified in Orthopedic surgery
- 5+ years of clinical experience in Orthopedic Surgery post
residency
- Demonstrated use and knowledge of coding and billing
practices
- Proficient computer skills to include MS Office (MS Word,
Excel, and Power Point)--Preferred
Qualifications:------------------
- Sub-Specialty training in Spine, Hand, Joint, Foot and Ankle or
Sport
- Experience with professional claim coding resources/claim
coding reviews and techniques
- Exhibits leadership skills in working with other physicians,
knowledge of the overall medical community and the local / regional
managed care environments
- 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 *All employees working remotely will be--required to
adhere to UnitedHealth Group's Telecommuter Policy----California,
Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island,
or Washington Residents Only: The salary range for California,
Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island
or Washington residents is $248,582 to $338,965. 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.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: OptumCare is an Equal Employment
Opportunity/Affirmative Action employers 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.--OptumCare is a drug-free
workplace. Candidates are required to pass a drug test before
beginning employment--
Keywords: UnitedHealth Group, Alexandria , Focus Claims Review - Medical Director, Orthopedic Surgery - Per Diem - Remote, Healthcare , Alexandria, Virginia
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