Medical Director - General Surgery - Remote from anywhere
Phoenix, Arizona, United States · Remote OK
$249k–$373k/yr
Senior$7.6B raised
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 ca…
Skills: Clinical Coding, Medical Claim Review, General Surgery, Medical Necessity Determination, Regulatory Compliance
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Why Mayo Clinic Mayo Clinic is top-ranked in more specialties than any other care provider according to U.S. News & World Report. As we work together to put the needs of the patient first, we are also dedicated to our em…
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West Saint Paul, Minnesota, United States · On-site
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East Grand Forks, Minnesota, United States · Remote OK
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Eden Prairie, Minnesota, United States · Remote OK
$113k–$193k/yr
Senior$7.6B raised
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Precertification and Authorization Rep - .8 FTE-Hybrid
Rochester, Minnesota, United States · Hybrid
$21/hr–$34/hr
Mid level$399M raised
Why Mayo Clinic Mayo Clinic is top-ranked in more specialties than any other care provider according to U.S. News & World Report. As we work together to put the needs of the patient first, we are also dedicated to our em…
Precertification and Authorization Rep - .8 FTE-Hybrid
Rochester, Minnesota, United States · Hybrid
$21/hr–$34/hr
Mid level$399M raised
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Medical Director - General Surgery - Remote from anywhere
The Medical Director provides leadership and direction for the claims review program, ensuring the quality and effectiveness of medical services. Key duties include reviewing surgical claims for correct coding and conducting telephonic discussions with providers regarding medical necessity.
Requirements
Candidates must hold an active, unrestricted medical license and board certification in General Surgery. A minimum of 5 years of clinical experience with brain and spine surgeries post-residency is required.
Full 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.
As part of the Focus Claims Review team at Optum, the Medical Director provides leadership, organization, and direction for the claims review program. They are responsible for the overall quality, effectiveness and coordination of the medical services provided through Optum. The Medical Director will participate in all aspects of claim review services including provider telephonic discussions and provider appeals. In addition, the Medical Director may also be asked to assist in the direction and oversight in the development and implementation of policies and procedures and clinical criteria for all medical programs and services. The Medical Director will serve as a liaison between Optum, physicians, and other medical service providers in selected situations primarily related to medical claim reviews.
You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
Reviews surgical and other professional claims for correct coding using clinical record
Participation in Training regarding URAC, NCQA, Regulatory Compliance, Confidentiality, Conflict of Interest, HIPAA, and department specific training as applicable
Discusses cases and clinical coding situations with treating providers telephonically during scheduled hours
Participates in periodic clinical conferences / calls and in ongoing internal performance consistency reviews
Composes, if needed, patient situation specific, clinical summaries and rationales for medical necessity decisions
Supports compliance with regulatory agency standards and requirements (e.g., CMS, NCQA, URAC, state / federal and third-party payers)
Provide Clinical support for staff that conduct initial reviews
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:
Current, active, and fully unrestricted medical license
Current board certification in General Surgery through the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA)
5+ years of clinical experience with brain and spine surgeries post residency
MS Office (MS Word, Excel, and Power Point)
Preferred Qualifications:
Experience working for a managed care organization
Experience with professional claim coding / claim coding reviews
Knowledge of claim coding resources and techniques
Proficient computer skills and ability to learn to use clinical and claims software
Proven excellent interpersonal skills and the ability to work over the telephone with other colleagues including physicians, nurses, PTs, OTs and other similar personnel
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 $248,500 - $373,000 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.
UnitedHealth Group is a health care and well-being company with a mission to help people live healthier lives and help make the health system work better for everyone.
We are 340,000 colleagues in two distinct and complementary businesses working to help build a modern, high-performing health system through improved access, affordability, outcomes and experiences.
Optum delivers care aided by technology and data, empowering people, partners and providers with the guidance and tools they need to achieve better health. UnitedHealthcare offers a full range of health benefits, enabling affordable coverage, simplifying the health care experience and delivering access to high-quality care.
We work with governments, employers, partners and providers to care for 147 million people and share a vision of a value-based system of care that provides compassionate and equitable care.
At UnitedHealth Group, our mission calls us, our values guide us and our diverse culture connects us as we seek to improve care for the consumers we are privileged to serve and their communities.
Click below to search careers or join our social communities:
• Search & apply for careers at careers.unitedhealthgroup.com/
• Follow us on Twitter at twitter.com/UnitedHealthGrp
• Follow and like us on Facebook at facebook.com/unitedhealthgroup
• Follow us on Instagram at instagram.com/unitedhealthgroup
More about UnitedHealth Group can be found at unitedhealthgroup.com/
Offices: Eden Prairie , Minnesota, US · 2716 N Tenaya Way, Las Vegas, NV 89128, US · 4425 E Cotton Center Blvd, Phoenix, AZ 85040, US · 1900 E Golf Rd, Schaumburg, IL 60173, US · 8822 Three Chopt Rd, Henrico, VA 23229, US
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Based on 2965 listings with disclosed salaries, most healthcare jobs in Minnesota pay between $70k–$187k per year. Individual offers vary with seniority, company size, and specialization.
How many Healthcare jobs are open in Minnesota right now?
There are currently 13,263 open healthcare positions in Minnesota listed on Clera. New openings are added daily as companies post roles.
Which companies are hiring for Healthcare roles in Minnesota?
Companies currently hiring include Mayo Clinic, Fairview Health Services, Children's Minnesota, Sanford Health, Essentia Health, among others. Browse the listings above to see every active employer.
Are there remote or hybrid Healthcare jobs in Minnesota?
Yes — 1825 of the 13263 open healthcare positions offer remote or hybrid work (592 remote, 1233 hybrid).
How do I apply for Healthcare jobs in Minnesota?
Each listing links directly to the employer's application page. Apply early — fresh listings get the most recruiter attention in the first two weeks.