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) 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.
Primary Responsibilities: * 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, schedule on-site visits, 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.
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All Rights Reserved * 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.
Required Qualifications: * Board certification a an MD, DO, MBBS, with a current unrestricted license to practice medicine.
Licensure in multiple states preferred; you should be willing to obtain addtional state licenses, with naviHealth’s support.
Reviewers must maintian necessary credentials to retain the position * At least 3 years of experience practicing in an acute inpatient environment, where dealing with managed care organizations made up at least half of inpatient practice * Understanding of population-based medicine with preference given to significant experience with the Medicare population * Strong business acumen, including working knowledge of changing U.S.
payer and provider landscape * Proficiency with MS Office Suite Preferred Qualifications: * Excellent organizational, verbal and written communication and presentation skills * Ability to work with others while completing multiple tasks simultaneously and successfully * Ability to complete assignments with reasonable oversight, direction, and supervision * Highly motivated, flexible and adaptable to working in a fast-paced, dynamic environment * Strong interpersonal skills and necessary business acumen to communicate and build positive relationships with management * Clear, concise and persuasive verbal and written communication * Must be able to positively interact with other clinicians, senior management, patients and their families, and all levels of medical and non-medical professionals * Excellent analytic skills * Highest level of ethics and integrity Work Conditions and Physical Requirements: * This position is remote 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) Colorado Residents Only: The salary range for Colorado residents is $254,600 to $295,200.
Pay is based on several factors including but not limited to education, work experience, certifications, etc.
As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance About naviHealth naviHealth is improving the healthcare experience for seniors to live more fulfilling lives.
For nearly a decade, naviHealth has been a trusted partner for the nation’s top health plans, health systems, and at-risk physician groups navigating the shift from volume to value.
Powered by a predictive technology and decision support platform that provides clinicians and care teams with evidence-based protocols, naviHealth’s high-touch, proven care model fully supports patients from pre-acute through to the home.
With naviHealth, patients can enjoy more days at home, and healthcare providers and health plans can significantly reduce costs specific to unnecessary care and readmissions.
For more information about naviHealth, visit www.navihealth.com.
Our Purpose Improving the healthcare experience for seniors to live a more fulfilling life Our Values Rooted in respect Guided by purpose Devoted to service Energized by impact The above statements are intended to describe the general nature and level of work performed by colleagues assigned to this job.
It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications.
naviHealth reserves the right to amend and change responsibilities to meet business and organizational needs as necessary.
naviHealth is an Equal Opportunity Employer.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other protected status under applicable laws and will not be discriminated against on the basis of disability.