We are currently seeking a dedicated Inpatient Care Management Medical Director to join our team. As part of our Optum division, you will play a crucial role in conducting acute level of care and length of stay reviews to ensure medical necessity for our diverse member base, which includes local and national commercial employer, Medicare, and state Medicaid plans. Collaborating with a team of nurses and support staff, you will oversee inpatient care utilization at various levels - hospital, market, regional, or national.
Primary ResponsibilitiesEngage in telephonic outreach to collaborate with treating providers, focusing on evidence-based guidelines, clinical quality improvements, and care plan adjustments that impact healthcare costs.
Collaborate with operational and business partners on clinical and quality initiatives at both site and customer levels to meet and exceed customer expectations.
Apply evidence-based medicine principles, utilizing tools such as InterQual care guidelines and criteria review.
Occasionally participate in market oversight meetings with Chief Medical Officers, network contractors, nurse management, and internal managers.
Maintain proficiency in all required software and platforms essential for effective performance.
While your focus will primarily be regional, you will work closely with a national team, contributing to program enhancements and operational modifications as needed.
Required QualificationsMD or DO with an active, unrestricted medical license.
Current Board Certification in an ABMS or AOBMS specialty.
Minimum of 5 years of clinical practice experience post residency.
Access to a private home office and high-speed Internet, facilitating seamless remote work.
Technical proficiency in various computer software and systems.
Preferred Qualifications2 years of managed care or Quality Management experience, along with administrative leadership exposure.
Prior experience in Utilization Management (UM).
Recent clinical experience within the past 2 years.
Employment Type: Full-Time