Regional Medical Director, NAMM Optum - Ontario, CA

UnitedHealth Group
Menifee, California
Apr 01, 2021
Apr 10, 2021
Organization Type
We at NAMM, a part of OptumCare, deliver a clearly differentiated level of outcome and
service adherence. Come join our team and add to our bench strength as we
execute on managed care 2.0 bringing together revenue optimization, appropriate
utilization, unit cost management and strategic acquisitions. Quality care
saves money without exception.

Careers at

We're on a mission to change the face of health care. As the largest health and
wellness business in the US, we help 58 million people navigate the health care
system, finance their health care needs and achieve their health and well-being
goals. Fortunately, we have a team of the best and brightest minds on the
planet to make it happen.

The Medical
interacts with Physicians and IPA staff to ensure that patient
needs are met in an efficient and medically appropriate manner. The Medical
Director of is responsible for the Medical Management functions that include vendor
relations, Utilization Management and business development. In addition, this
role provides prime management, oversight and
development for major program and functional areas within Medical Management.
These include medical policy, patient centered medical home, Medicaid, Health
and Wellness, population management, and reporting capabilities. The Medical
Director is also responsible for working with physicians and other providers,
especially PCMH practices, to improve the quality and efficiency of care in the
network and integrate these providers into clinical initiatives.

Primary Responsibilities:

  • Works
    primarily with the physician
    community around issues of particular patients, balancing business and
    clinical concerns.
  • Provides
    limited utilization management for outpatient medical,
    surgical and pharmacy activity.
  • Participates
    in medical appeals activity. Reviews all 2 nd -level overturned
    cases related to medical necessity/investigational issues in the context
    of potential medical policy updates.
  • Works
    with the Appeals area on appeals related to utilization management issues.
  • Provides
    medical leadership and physician advice to the quality management area
    with respect to quality improvement studies, quality improvement
    committees, primary care assessments (both office-site assessments and
    medical record document reviews).
  • Performs
    peer reviews on quality complaints, sentinel events, and quality-of-care
  • Serves
    as Physician Advisor for other areas within the company, including but not
    limited to Sales and Marketing, Underwriting, PHP, and Provider Services.
  • Provides
    medical leadership and advice for conformance with standards and
    guidelines for NCQA, URAC, state and federal regulators, and other
    accrediting bodies.
  • Acts
    as liaison for communication with physicians, hospitals, and other
    providers in the community.
  • Reviews
    customer service and claims inquiries.


  • Possess a current and unrestricted MD or DO license in
  • 3 or more years of experience working as a Medical
    Director in a managed care setting
  • 3 or more years of experience in utilization
    management, utilization review and prior authorization
  • 3 or more years of experience interacting with both
    group and IPA Physicians
  • Experience with
    inpatient/hospitalist management
  • Experience with and comfort level in
    supervising Advanced Practice Clinicians
  • Board certification in their chosen specialty
  • If
    you need to enter a work site for any reason, you will be required to screen
    for symptoms using the ProtectWell mobile app, Interactive Voice Response
    (i.e., entering your symptoms via phone system) or similar UnitedHealth
    Group-approved symptom screener. When in a UnitedHealth Group building,
    employees are required to wear a mask in common areas. In addition, employees
    must comply with any state and local masking orders

Preferred Qualifications:

  • Prior experience working with clinical information
    technology systems
  • Public presentation skills

What's the first thing that happens
when one of the most successful groups in Riverside County comes together with
a global leader in health care? Opportunity. With NAMM joining OptumCare and
the UnitedHealth Group family of companies, people like you will find
increasing levels of challenge, impact and professional success. With a vibrant
network of hospitals and urgent care centers, we're changing health care for
the better by improving access to affordable, high quality care, and working
together to improve the patient experience. That takes passion, commitment,
intense focus and the ability to contribute effectively in a highly
collaborative team environment. Are you with us? Learn more about this exciting
opportunity to do your life's best work.(sm)

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal
Employment Opportunity/Affirmative Action employer and all qualified applicants
will receive consideration for employment without regard to race, color,
religion, sex, age, national origin, protected veteran status, disability
status, sexual orientation, gender identity or expression, marital status,
genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass
a drug test before beginning employment.

Job Keywords: Medical Director, MD,
DO, managed care, UM, Utilization Management, CM, Case Management, IPA,
clinical informatics, Ontario, Riverside, San Bernardino, San Diego, CA, Telecommute