Remote Program Cost Control Analyst Jobs in Roxana, IL

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 Medical Director will partner with cross-functional teams and senior leaders to ensure that Optum leads the industry in innovative health management strategies and is considered an expert in the field of post-acute care. The role as a physician leader, has 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 Optum's corporate wide strategies.

You'll enjoy the flexibility to work remotely * 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
• Daily UM reviews - authorization and denial reviews
• Conduct peer to peer conversations for clinical case reviews as needed
• Conduct provider telephonic review and discussion, share tools, information, and guidelines as they relate to cost-effective healthcare delivery and quality of care
• Communicate effectively with providers to ensure the successful administering of Optum's services
• Respond to clinical inquiries and serve as a non-promotional medical contact point for various healthcare providers
• Collaborate with Team to ensure a coordinated approach toward our member's health care
• The development of action plans and programs to implement strategic initiatives and tactics to address areas of concern and monitor progress toward goals
• Provide leadership and guidance to maximize cost management through close coordination with network and provider contracting
• Regularly meet with Optum'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 Care Management Team to better enhance Optum'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
• 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:

• Graduate of a recognized accredited medical school
• Current, unrestricted medical license and residency in the United States
• Board certified in a recognized ABMS specialty
• Board Certified in Internal Medicine
• 3 years of experience practicing in an acute inpatient environment, where dealing with managed care organizations made up at least half of inpatient practice
• Proven working knowledge of changing U.S. payer and provider landscape
• Proven understanding of population-based medicine with preference given to significant experience with the Medicare, Medicaid, and Commercial populations
• Proficient computer skills
• Dedicated office/work area established that is separated from other living areas and provides privacy
• Reside in a location that can receive a high-speed internet connection

Preferred Qualifications:

• Demonstrated ability to work with others while completing multiple tasks simultaneously and successfully
• Demonstrated ability to complete assignments with reasonable oversight, direction, and supervision
• Demonstrated ability to be highly motivated, flexible, and adaptable to working in a fast-paced, dynamic environment
• Demonstrated ability to positively interact with other clinicians, senior management, and all levels of medical and non-medical professionals
• Demonstrated ability to quickly adapt to change and drive innovation within team and market
• Demonstrated ability to work across functions and businesses to achieve business goals
• Demonstrated ability to develop and maintain positive customer and provider relationships
• Proven solid interpersonal skills and necessary business acumen to communicate and build positive relationships with management
• Proven high level of organizational skills, self- motivation, and ability to manage time independently
• Proven excellent organizational, verbal, and written communication and presentation skills
• Proven excellent analytic skills

*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.

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.