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- Las Vegas, NV
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Behavioral Medical Director (Psychiatrist), Appeals and Grievances - Telecommute
UnitedHealth Group • Las Vegas, NV
Posted 11 days ago
Optum Behavioral Health focuses on engaging people, solving problems and making clinical judgments to improve the experience of individuals living with behavioral health issues.
We are currently seeking a Behavioral Medical Director (Psychiatrist) to join our National Appeals and Grievances Team. Working within a subset of Optum Behavioral Health, the Behavioral Medical Director position is responsible for maintaining the clinical integrity of the program, including timely peer reviews, appeals and consultations with providers and other community based clinicians, including general practitioners. They work collaboratively with the Health Plan Medical Director, Clinical, Network and Quality staff as well as interact directly with Psychiatrists, Prescribers, and other clinical professionals who consult on various processes and programs.
As part of a leadership team, they are also responsible for managing the development and implementation of medical expense initiatives, advising leadership on improvement opportunities regarding medical expense programs and clinical activities that impact medical expense. In addition, the Medical Director will be critical in evaluating appeals and monitoring trends at a national level while further standardizing the member and provider appeals process. At Optum, our clinical vision drives the team to improve the quality of care our consumers receive.
- Responsible for making clinical coverage determinations in accordance with the terms of members’ benefit plans, clinical policies, and objective and evidence - based written clinical guideline
- Responsible for oversight and management, along with the Clinical Director and Clinical Program Director, utilization review, management and care coordination activities
- Provide clinical oversight to the clinical staff, oversee the management of services at all levels of care in the benefit plan
- Adhere to all applicable turnaround time requirements in making coverage determinations, appeal / dispute review decisions, and complaint review decisions, and in notifying members and/or the practitioners in writing, and verbally when required
Doctor of Medicine or Osteopathy
Current license to practice as a physician without restrictions
Board certified in Psychiatry
Demonstrated understanding of the clinical application of the principles of engagement, empowerment, rehabilitation and recovery
Knowledge of post - acute care planning such as home care, discharge planning, case management, and disease management
Minimum of 3 years of experience as a practicing psychiatrist post residency
Board certified in Child & Adolescent Psychiatry
Experience in public sector delivery systems such as Medicaid and Medicare
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)
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.
Keywords: Psychiatrist, Behavioral, Physician, Clinical, Appeals