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.

Why Care Transitions? At Care Transitions, our mission is to work with extraordinarily talented people who are committed to making a positive and powerful impact on society by transforming health care. We do health care differently and we are changing health care one patient at a time. You will have a genuine passion and energy to grow within an aggressive and fun environment, using the latest technologies in alignment with the company's technical vision and strategy.

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 - authorizations and denial reviews

Conduct peer to peer conversations for the clinical case reviews, as needed

Conduct provider telephonic review and discussion and share tools, information, and guidelines as they relate to cost-effective healthcare delivery and quality of care

Communicate effectively with network and non-network providers to ensure the successful administering of Care Transitions' services

Respond to clinical inquiries and serve as a non-promotional medical contact point for various healthcare providers

Represent Care Transitions on appropriate external levels identifying, engaging and establishing/maintaining relationships with other thought leaders

Collaborate with Client Services Team to ensure a coordinated approach to delivery system providers

Contribute to the development of action plans and programs to implement strategic initiatives and tactics to address areas of concern and monitor progress toward goals

Interact, communicate, and collaborate with network and community physicians, hospital leaders and other vendors regarding care and services for enrollees

Provide leadership and guidance to maximize cost management through close coordination with all network and provider contracting

Regularly meet with Care Transitions' 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 Client Services Team to better enhance Care Transitions' 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

Participate on the Medical Advisory Board

Providing intermittent, scheduled weekend and evening coverage

Perform other duties and responsibilities as required, assigned, or requested

Required Qualifications:

MD or DO degree

Active, unrestricted physician state license

Current board certification in ABMS or AOA specialty

5+ years of clinical practice experience post residency

Solid understanding of and concurrence with evidence-based medicine (EBM) and managed care principles

Preferred Qualifications:

Hands‑on utilization and/or quality management experience

Project management or active project participation experience

Substantial experience in using electronic clinical systems

Compensation: Compensation for this specialty generally ranges from $238,000 to $357,500. 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.

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.

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