Medical Director - Clinical Review - CA, AZ or NM licensure - Remote [15h Left]
Company: Optum
Location: San Diego
Posted on: July 7, 2025
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Job Description:
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. Clinical Excellence, a national OptumCare team, is
currently seeking an experienced National Medical Director to join
our growing Value Innovations efforts. This key Physician will
provide expertise and leadership on population, specifically
Clinical Documentation Review with expertise in application of DRG
coding and clinical operations. This position joins a team in the
process of rapid expansion of both new and existing value-based
initiatives and programs. At Clinical Excellence, our mission is
effective implementation, monitoring, & execution of clinical
programs that improve the patient & provider experience, while
delivering superior outcomes at a sustainable cost. We aim to
achieve repeatable, practical, sustainable, & compliant solutions
that deliver value to the OptumCare businesses. We serve as
national support for our internal physician groups in achieving
clinical improvement or capability-building initiatives. This
physician will be comfortable working consistently and, for the
most part, independently performing timely clinical chart reviews.
At times, responsibilities will require interacting with clinicians
as well as operational colleagues including an experienced CDI
team, other medical directors, and frontline driven operational
staff. The successful candidate will be able to drive value in
existing workstreams, providing consistent, quality DRG-based
clinical reviews, engage in peer-to-peer conversations, and be
willing to expand to other ad hoc request including participation
in pilots, conceptualization and problem solving around other
related domains. Leadership responsibilities may include
representing the programs under their leadership in senior
executive meetings, lead reviews, and improvements of clinical
programs and processes, and being a financial steward in areas of
responsibility. You’ll enjoy the flexibility to work remotely *
from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities: - Provide consistent high-quality
DRG-based clinical reviews within the Optum Enterprise Innovative
DRG Clinical Review program and be an excellent written and spoken
communicator (e.g., communication letters, engagement in
peer-to-peer conversations) - Close collaboration with a team of
medical directors, nurse coders, and operations team to deliver DRG
Clinical Review performance - Identifying opportunities expand and
optimize program success in collaboration with other programs, such
as hospital utilization management and claims adjudication teams -
Collaborate with IT partners to implement AI enhancements within
programs - Participate in other Value Innovation programs, as
assigned - Change Management - Participate in the cross
collaboration with regional care delivery organizations through OH
and Payment Integrity - Closely partner with IT on development and
implementation of program delivery - Emotional Maturity and EQ -
Establishing strong and lasting, trust-based relationships within
team and external partners - Foster exemplary teamwork and
strengthen a culture of continuous improvement and accountability -
Take initiative and self-start attitude to approach problems with
energy and passion - Demonstrate preference for working in a
tight-knit team environment with diverse professional groups 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: -
M.D. or D.O. with an active, unrestricted medical license - Board
certified in adult primary care fields (e.g. Internal Medicine,
Family Medicine, Hospitalist) or related subspecialties - Licensed
in CA, NM or AZ - 3 years of clinical experience post residency
Preferred Qualification: - Experience with DRG clinical
documentation and/or coding team collaboration within a hospital
system or payor - Experience in chart review (DRG, UM, PA) or prior
role as hospital physician advisor - Experience as a hospitalist
*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 $269,500 to $425,500 annually
based on full-time employment. We comply with all minimum wage laws
as applicable. 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.
Keywords: Optum, Mission Viejo , Medical Director - Clinical Review - CA, AZ or NM licensure - Remote [15h Left], Healthcare , San Diego, California