naviHealth, part of Optum and the UnitedHealth Group family of businesses, combines the talents of our dedicated staff and leading-edge technology to deliver compassionate care to seniors nationwide. With millions of lives touched, we are innovating the way health care is delivered from hospital to home so seniors can lead more fulfilling lives. A career with us means making an impact in the lives of those we serve, including vulnerable populations who benefit from care that is more efficient, more effective and more human. Our environment empowers our team members to elevate our interactions with each other and the experiences we deliver to our patients, giving them more days at home. Join our team, it’s your chance to improve the lives of millions while doing your life’s best work.(sm)
At naviHealth, 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. naviHealth 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.
The Medical Director will partner with cross-functional teams and senior leaders to ensure that naviHealth leads the industry in innovative health management strategies and is considered an expert in the field of post-acute care. The role is a physician leader with a proven track record of innovation, achievement of measurable goals, and exceptional clinical competencies. They take a proactive approach to the marketplace and are responsible for continuously reshaping naviHealth’s corporate-wide strategies.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
- Provide daily utilization oversight and external communication with network physicians and hospitals
- Responsible for 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 naviHealth’s services
- Respond to clinical inquiries and serve as a non-promotional medical contact point for various healthcare providers
- Represent naviHealth 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 naviHealth’s 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 naviHealth’s 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
- Responsible for 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 as well as provide development for other roles you may be interested in.
- Board certification as an MD, DO, MBBS with a current unrestricted license to practice and maintain necessary credentials to retain the position
- Current, unrestricted medical license and the ability to obtain licensure in multiple states
- 3+ years of post-residency patient care, preferrably in inpatient or post-acute setting
Work Conditions and Physical Requirements:
- Understanding of population-based medicine, preferrably with knowledge of CMS criteria for post-acute care
- Licensure in multiple states
- Willing to obtain additional state licenses, with naviHealth’s support
- Excellent organizational, analytical, verbal and written communication skills
- Ability to work within a team environment while completing multiple tasks simultaneously
- Ability to complete assignments with reasonable oversight, direction, and supervision
- Highly motivated, flexible and adaptable to working in a fast-paced, dynamic environment
- Solid interpersonal skills with ability to communicate and build positive relationships with colleagues
- Able to positively interact with other clinicians, management, and all levels of medical and non-medical professionals
- Highest level of ethics and integrity
- Demonstrated competence in use of electronic health records as well as associated technology and applications
- Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance
- Using phone and computer in a full day of authorization reviews, peer to peer discussions, interaction with colleagues, team members, and management
- Ability to establish a home office workspace
- Ability to manipulate laptop computer (or similar hardware)
- Ability to view screen and enter data into a laptop computer (or similar hardware) within a standard period of time
- Ability to communicate including use of cellular phone or comparable communication device
- Ability to remain stationary for extended time periods (1 - 2 hours)
Being a pioneer in post-acute management and care transitions with 19 years of experience, naviHealth is uniquely positioned to manage patients, improve clinical and financial outcomes, and share risk with payors and providers. We provide clinical service support alongside proprietary technology and advisory solutions that empower health systems, health plans and post-acute providers to navigate care episodes across the continuum, with the goal of reducing waste and improving patient outcomes.
UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.
Careers at UnitedHealth Group. We have modest goals: Improve the lives of others. Change the landscape of health care forever. Leave the world a better place than we found it. Such aspirations tend to attract a certain type of person. Crazy talented. Compassionate. Driven. To these select few, we offer the global reach, resources and can-do culture of a Fortune 10 company. We provide an environment where you're empowered to be your best. We encourage you to take risks. And we offer a world of rewards and benefits for performance. We believe the most important is the opportunity to do your life's best work.(sm)
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
Colorado Residents Only: The salary range for Colorado residents is $176,700 to $291,600. 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.
For more information on our Internal Job Posting Policy, [ Link removed ] - Click here to apply to Medical Director Post-Acute Care Management - US Telecommute.
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer 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.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
Job Keywords: Post-Acute Care Management Medical Director, Telecommute, Telecommuter, Telecommuting, Work at Home, Work from Home, Remote