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 Care Transitions (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 Care Transitions? At Care Transitions, 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. Care Transitions 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 #J-18808-Ljbffr