Medical Director - Clinical Review - CA, AZ or NM licensure - Remote [15h Left]

Company: Optum
Location: San Diego
Posted on: July 7, 2025

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