For those who want to invent the future of health care, here's your opportunity. We're going beyond counseling services and verified referrals to behavioral health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm) 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 an Associate Behavioral Medical Director (Psychiatrist) to join our National Appeals and Grievances Team. Working within a subset of Optum Behavioral Health, the Associate 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 AMD 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. Primary Responsibilities:Responsible for making clinical coverage determinations in accordance with the terms of members' benefit plans, clinical policies, and objective and evidence - based written clinical guidelineResponsible for oversight and management, along with the Clinical Director and Clinical Program Director, utilization review, management and care coordination activitiesProvide clinical oversight to the clinical staff, oversee the management of services at all levels of care in the benefit planAdhere 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
Required Qualifications:Doctor of Medicine or OsteopathyCurrent license to practice as a physician without restrictionsBoard certified in PsychiatryDemonstrated understanding of the clinical application of the principles of engagement, empowerment, rehabilitation and recoveryKnowledge of post - acute care planning such as home care, discharge planning, case management, and disease managementPreferred Qualifications:Minimum of 3 years of experience as a practicing psychiatrist post residency Board certified in Child & Adolescent Psychiatry Experience in public sector delivery systems and experience in state specific public sector services Experience working with community based programs and resources designed to aid the State Medicaid populationCareers 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. Job Keywords: Healthcare, Medical, Clinical, Licensed, Psychiatry, Psychiatrist, Telecommute, Appeals
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.