Medical Director - Neurosurgery - Remote
Company: Optum
Location: New York
Posted on: May 12, 2025
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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 Focus Claims Review team at Optum, 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 Optum. 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. -The
Medical Director 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 -
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 occasional, 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 travel to scheduled company meetings and activities in
US -
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 -
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:
MD or DO
Current, active, and fully unrestricted medical license -
Current board certification in Neurosurgery
5+ years of clinical experience in Neurosurgery; experience in
spinal surgery post residency
MS Office (MS Word, Excel, and Power Point) -
Preferred Qualifications:
Experience in managed care -
Experience with professional claim coding / claim coding reviews
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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 -
Knowledge of claim coding resources and techniques
Proficient computer skills and ability to learn to use clinical and
claims software -
Proven excellent interpersonal skills and the ability to work over
the telephone with other colleagues including physicians, nurses,
PTs, OTs and other similar personnel
*All employees working remotely will be required to adhere to
UnitedHealth Group's Telecommuter Policy. -
The salary range for this role is $238,000 to $357,500 per year.
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.
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. - -
UnitedHealth Group is an Equal Employment Opportunity employer
under applicable law and qualified applicants will receive
consideration for employment without regard to race, national
origin, religion, age, color, sex, sexual orientation, gender
identity, disability, or protected veteran status, or any other
characteristic protected by local, state, or federal laws, rules,
or regulations. -
UnitedHealth Group is a drug - free workplace. Candidates are
required to pass a drug test before beginning employment.
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Keywords: Optum, Fairfield , Medical Director - Neurosurgery - Remote, Executive , New York, Connecticut
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