Remote Prior Authorization Representative Express Scripts Jobs in Minnesota

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The National Medical Director of Radiology and Imaging Programs is responsible for leading the strategy, design, development, and oversight of payer-led radiology and imaging programs across UnitedHealthcare. This role will guide the modernization of radiology health plan medical management programs, including utilization management, prior authorization, post-service clinical review, clinical decision support, and evidence-based care pathways, with the goal of improving affordability, quality, provider experience, and member outcomes.
This position will be reasonable for integrating UHC's largest PA programs for Radiology and Cardiology which currently provides $425M or 19% of the direct medical expense savings.  The position will also support UM modernization including increasing automation and reducing denials, and developing bundled authorizations, further contributing to reducing operating expenses and simplifying the prior authorization process.

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.  

For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.  

Primary Responsibilities:

• Clinical Strategy Leadership in Program Design and Development
  • Possess solid clinical and operational knowledge having worked in the designated medical specialty of Radiology and Imaging
  • Oversee the strategy for health plan Radiology and Imaging specialty programs using knowledge and understanding of the healthcare industry, emerging technology and trends, and current medical specialty guidelines and peer-reviewed literature, incorporating feedback from key stakeholders
  • Lead the design of clinical program development for modernizing utilization management and retrospective clinical review programs across the continuum of Radiology and Imaging procedures to improve health outcomes with a focus on member and provider experience
  • Provide leadership and clinical insights for Radiology and Imaging category activities across the enterprise such as value-based care programs, quality improvement initiatives, and care management
• Process Optimization 
  • Identify pain points in current prior authorization processes and propose innovative solutions
  • Support effective implementation in partnership with teams in clinical operations and technology
  • Participate in the development of pilot programs and evaluate performance metrics for automation initiatives
  • Build and develop relationships across teams to ensure effective feedback loops and that deliverables are met
  • Set and review program metrics for continuous enhancements, updates, and improvement
• Data and Technology Proficiency
  • Assess and interpret complex financial and clinical data to evaluate feasibility of proposed initiatives
  • Direct the healthcare analytics team as they work through hypothesis and problems and synthesize the results and to assure model assumptions are accurate
  • Evaluate clinical, quality and claims data to identify opportunities for improvement of clinical programs
  • Provide clinical insights and input to guide technology partners in development of large language learning models and technical capabilities for care pathways and bundled authorizations
• Communication, Collaboration and Relationship Building
  • Articulate and represent UHC clinical strategy to executive leaders across the enterprise and to external stakeholders and be able to speak clearly on complex problems
  • Advocate with leadership across the organization to create better alignment with business segments, network, and functional areas, thereby ensuring internal and external coordination and a unified approach to the market and associated constituents
  • Coordinate efforts of clinical, network, operations and HCE teams to support expansion of value-based programs delivered through our providers
  • Create and maintain solid relationships with key clinical leaders across the organization
• Clinical Expertise
  • Collaborate with the CMO, clinical, network and business leaders on top priorities and goals
  • Participate in key clinical committees
  • Solicit or respond to input on clinical initiatives
  • Influence development of clinical communications that will be delivered to external audiences. (e.g., new clinical policies, programs, processes)
  • Participate in the response development and delivery to high level questions, concerns and complaints from regulators, accreditors, legal/risk management, employers, healthcare providers, and other stakeholders
  • Discuss clinical program outcomes, data and performance with providers, employers, accreditors and regulators

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:

• Doctorate of Medicine (MD or DO) degree with active/unrestricted medical license in one of more states
• Board certified in Radiology or related specialty required
• 10 years of clinical practice experience required

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy   

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. 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. The salary for this role will range from $200,400 to $343,500 annually based on full-time employment. We comply with all minimum wage laws as applicable.

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.