Optum Utilization Review Jobs (NOW HIRING)

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.
The Behavioral Medical Director position is responsible for providing oversight to and direction of the Utilization Management Program and performing peer reviews as necessary. This individual will interact directly with and offer clinical, procedural, or administrative recommendations to psychiatrists and other behavioral health providers, medical physicians and nurses, clinical professionals, and/or state agencies who care for members, or consult on various processes and programs. The Medical Director is part of a leadership team that manages development and implementation of evidence-based treatments and medical expense initiatives and will also advise leadership on health care system improvement opportunities. They are 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, and will work collaboratively with the Health Plan Medical Director, Clinical, Network and Quality staff. At Optum, our clinical vision drives the team to improve the quality of care our consumers receive.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:

• Collaborate with the Utilization Management and Care Management teams to ensure delivery of cost-effective quality care that incorporates recovery, resiliency and person-centered services
• Partner with the internal UM and CM teams, Health Plan, NJ state and the Providers
• Responsible for Level of Care guidelines and utilization management protocols
• 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
• Keep current regarding Evidence Based Practices and treatment philosophies including those that address Recovery and Resilience

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:

• Doctor of Medicine or Osteopathy
• Current license to practice as a physician without restrictions in the state of New Jersey
• Board certified in Psychiatry
• Knowledge of post-acute care planning such as home care, discharge planning, case management, and disease management
• Demonstrated understanding of the clinical application of the principles of engagement, empowerment, rehabilitation and recovery
• Familiar with Substance Use Disorders, ASAM and treatment modalities including MAT (Medication Assisted Treatment)
• Computer and typing proficiency, Microsoft Outlook and Teams, and data analysis
• Currently reside in the state of New Jersey

Preferred Qualifications:

• 3+ years of experience as a practicing psychiatrist post residency
• Managed care experience
• 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 population

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Compensation for this specialty generally ranges from $268,000 - $414,000. 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.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.