This position will support the growing Prior Auth program which covers the California Market. The scope of this role will include Prior Authorization for Medicare Advantage members focusing on high value procedures such as Myocardial SPECT, PET scans, DME/Home Ventilator, Genetic Testing, and many more. Additionally, the team handles UM functions for the California Market.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:- Work to improve quality and promote evidence-based medicine
- Prior authorization, utilization management and claims review cases for patients
- Provide information on quality and efficiency to doctors, patients and customers to inform care choices and drive improvement
- Support initiatives that enhance quality throughout our national network
- Ensure the right service is provided at the right time for each member
- Work with medical director teams focusing on inpatient care management, clinical coverage review, member appeals clinical review, medical claim review and provider appeals clinical review
- Success in this technology-heavy role requires exceptional leadership skills, the knowledge and confidence to make autonomous decisions and an ability to thrive in a production-driven setting
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:- MD or DO degree
- Active, unrestricted physician state license in CA
- Current board certification through the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA)
- 5+ years of clinical practice experience post residency
- Proven solid understanding of and concurrence with evidence-based medicine (EBM) and managed care principles
Preferred Qualifications:- Hands-on utilization and/or quality management experience
- Prior Authorization experience
- Project management or active project participation experience
- Substantial experience in using electronic clinical systems
- Licensure in New Mexico, Utah, Nevada, or Arizona (or willing and able to obtain)
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Compensation for this specialty generally ranges from $248,500.00 to $373,000.00. Total cash compensation includes base pay and bonus and is based on several factors including but not limited to local labor markets, education, work experience and may increase over time based on productivity and performance in the role. We comply with all minimum wage laws as applicable. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
