Market Medical Director - West Valley, UT (Ferron)

UnitedHealth Group in Ferron, UT

  • Industry: Healthcare - Allied Health - Medical Technologist (MLS)
  • Type: Full Time
  • Compensation: $161,455.00 - 186,420.00 / Year*
position filled

OptumCare is seeking a Market Medical Director to join our Clinical Analysis and Consulting Team in West Valley, UT. You will have the opportunity to drive measureable and meaningful outcomes in the Salt Lake City Market with other members of the team. You will be responsible for improving the quality and efficiency of medical care in the market, and leading the provider network.

Primary Responsibilities:
  • This role will require you to be out in the field with daily travel within the Salt Lake City market, developing and maintain collegial relationships with contracted Providers in efforts to support the business efforts of the organization
  • Provide physician support to Clinical Coverage Review (CCR) operations, the organization responsible for the initial clinical review of service requests for UnitedHealth Care (UHC)
  • Collaborate with CCR leadership and staff to establish, implement, support and maintain clinical and operational processes related to benefits coverage determinations
  • Conduct coverage review based on individual member plan documents, and national and proprietary coverage review guidelines, render coverage determinations, and discuss with requesting providers as needed peer-to-peer
  • Use clinical knowledge in the application and interpretation of UHC medical policy and benefit document language in the process of clinical coverage review for UnitedHealth Care
  • Provide support for CCR nurses and non-clinical staff in multiple sites in a manner conducive to teamwork
  • Communicate and collaborate with network providers in pursuit of accurate and timely benefit determinations for plan participants; educates providers on benefit plans and UHC medical policy
  • Communicate and collaborate with other departments such as the Inpatient Concurrent Review team regarding coverage and other issues
  • Access clinical specialty panel to assist or obtain assistance in complex or difficult cases
  • Document clinical review findings, actions and outcomes in accordance with CCR policies, and regulatory and accreditation requirements
  • Actively participate as a key member of the CCR team in regular meetings and projects focused on communication, feedback, problem solving, process improvement, staff training and evaluation and sharing of program results
  • Provide clinical and strategic leadership when participating on national committees and task forces focused on achieving Clinical Coverage Review goals

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.

Required Qualifications:

  • M.D. or D.O.
  • Active, unrestricted Utah Medical License
  • Current Board Certification in ABMS or AOA specialty
  • 5+ years of clinical practice experience post residency
  • 5+ years hands-on experience in utilization and coverage review in a health plan with commercial and or Medicare Advantage membership
  • Ability to travel within the Salt Lake market the majority of the time

Preferred Qualifications:

  • Strong understanding of and concurrence with evidence-based medicine (EBM) and managed care principles
  • Supervisory skills, including clinical mentoring and coaching expertise
  • Project management background
  • Team player and strong teambuilding skills
  • Creative problem solving skills
  • Excellent presentation skills for both clinical and non-clinical audiences
  • Experience as a practicing physician in value based and/or Global Risk Model

OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare's support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.

Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.

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

Job Keywords: Market Medical Director, West Valley, UT, Utah

Associated topics: care, clinic, family practice, family practice physician, nocturnist, practice, practice physician, practitioner, primary care, urgent care

* Estimated salary

You may be interested in these similar jobs near Ferron, UT!

Great Locums Position in West Valley City, Utah- Locums/Travel (Ephraim)
SUMO Staffing

Family Practice/Primary Care opening in , Utah. This and other nurse practitioner jobs brought to you by NursingJobCafe.comWe are looking for a Nurse…

Read More
Family Nurse Practitioner- Part-Time/Contract (Ephraim)
All Medical

Family Practice/Primary Care opening in , Utah. This and other nurse practitioner jobs brought to you by NursingJobCafe.comSpecialty: Family Practice…

Read More
Permanent ObGyn Physician in Utah (Ferron)
Priority Physicians

ObGyn physician employment in Utah : CompHealth is currently seeking a ObGyn Physician in UT! CompHealth is currently assisting a group in Utah with …

Read More
Experienced Psychiatric Advanced Practitioner Position 20 Minutes from Downtown Salt Lake City, UT- Permanent/Full-Time (Castle Dale)
Opportunity Healthcare

Psychiatric-Mental Health opening in , Utah. This and other nurse practitioner jobs brought to you by NursingJobCafe.comPsychiatric Mental Health pro…

Read More
Austin Major Group

Family Practice/Primary Care opening in , Utah. This and other nurse practitioner jobs brought to you by NursingJobCafe.comVA Outpatient Clinic has a…

Read More
Regional Sales Manager, UT (Castle Dale)
Management Recruiters International

Promote value-added health products to existing and target customers in UTAH and surrounding states to meet or exceed sales budget and contribute …

Read More
Post-Acute Care Nurse Practitioner opportunity in Salt Lake City, UT- Permanent/Full-Time (Ferron)
All Star Recruiting

Critical Care/ICU/PICU/NICU opening in , Utah. This and other nurse practitioner jobs brought to you by NursingJobCafe.comLarge Post-Acute Care pract…

Read More
Locums General Surgeon Wanted in Utah (Manti)

A facility in Utah seeks a general surgeon to assist with locum tenens coverage. The covering physician must be comfortable with trauma cases. The as…

Read More
Interventional Cardiologist (Huntington)

An accredited chest pain center is seeking an interventional cardiologist for locum tenens coverage to assist with call/schedule relief.The facility …

Read More
UT Facility Needs a Locums Family Medicine Physician (Ephraim)

A facility located in Utah is seeking a family medicine physician to help with locum tenens coverage. The candidate must be board certified or board …

Read More