United Shared Services Medical Director - Great telecommuting opportunity from a

The Medical Director provides physician support to Clinical Coverage Operations, the organization responsible for the initial clinical review of service requests and the clinical review of adverse benefit determinations for UnitedHealth Group. The Medical Director collaborates with Chief Medical Officer(s), National Medical Director(s), Clinical Coverage Operations leadership and Clinical Coverage Operations staff to establish, implement, support and maintain clinical and operational processes related to benefit coverage determinations. The Medical Director's activities primarily focus on application of clinical knowledge to the benefit coverage process and communication regarding this process with both network and non-network physicians, as well as other UnitedHealth Group Medical Directors.

Job responsibilities include:

Conducts daily clinical review and evaluation of all service requests both independently and collaboratively with Clinical Coverage Operations staff.

Applies clinical knowledge to the application and interpretation of UHG medical policy and benefit document language in the process of clinical coverage review for UnitedHealth Group.

Provides clinical and strategic leadership for nurses in multiple sites, regularly participating in staff education.

Communicates and collaborates with network and non-network physicians in pursuit of accurate and timely benefit determinations for plan participants; educates physicians on benefit plans and UHG medical policy.

Communicates with Care Coordination clinical staff regarding benefit decisions and clinical case information that may impact Care Coordination

Communicates with Health Plan Medical Directors regarding access, availability, network, and quality issues

Is available and accessible to the Clinical Coverage Operations staff throughout the day to respond to clinical issues. Serves as a clinical resource, coach and leader for Clinical Coverage Operations.

Accesses clinical specialty panel physicians to assist in complex or difficult cases.

Documents clinical review findings, actions and outcomes in accordance with Clinical Coverage Operations policies, meeting UnitedHealthcare inter-rater reliability requirements.

Actively participates as a key member of the Clinical Coverage Operations leadership team in regular meetings focused on communication, feedback, problem solving, process improvement, staff training and evaluation and sharing of program results.

Provides clinical and strategic leadership when participating on national committees and task forces focused on achieving Clinical Coverage Operations goals.

Qualifications:

Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.