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UnitedHealth Group Senior Behavioral Medical Director - Remote in Pittsburgh, Pennsylvania

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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

At Optum, our mission is to make the health system work better for all. We are currently looking for a Senior Behavioral Medical Director to serve as the clinical team leader for the state of Michigan Clinical Management Program, supporting members in the commercial and Medicare Advantage space. The successful candidate will be accountable for the strategic approach to executing our annual business objectives in alignment with the larger organization. They will work collaboratively with other functional partners such as Care Advocacy, Case Management, Quality Improvement, State and Legal Compliance, providing medical subject matter expertise. The MD is also actively involved in the implementation, supervision, oversight, and evaluation of the Utilization Management program, develops, and implements Utilization Management policies and procedures, monitors the consistency with which Utilization Management criteria are applied; through supervision, case review, training, and consultations with Peer Reviewers, making coverage decisions and participates in committee meetings. Additionally, the Medical Director serves as the liaison with network providers and the medical delivery system.

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

  • Serve as the lead physician for the Behavioral Health plan

  • Develop programs to promote integration of physical and behavioral health services which support continuity and coordination among all network providers

  • Overall responsibility for implementation of the Utilization Management program

  • Monitor behavioral healthcare utilization authorization and claims data for all healthcare services

  • Assure that policies adhere to contractual obligations

  • Develop targeted education and training for, and provide clinical guidance to, the Care Advocates

  • Supervision and mentorship to clinical team

  • Perform Clinical Case reviews in conjunction with Clinical and Quality departments

  • Consultation with Michigan Behavioral Health providers

  • Participation in clinical workgroups as required

  • Participation in committees as required

  • Collaborate in provider initiatives and engagement

  • Oversight of clinical decision-making

  • Facilitate coordination of core business functions across business units; Oversee the clinical administrative operations of the program to ensure appropriate services are provided under the contract

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:

  • Doctor of Medicine or Osteopathy

  • Current license to practice as a physician without restrictions in the state of Michigan or be willing to obtain MI licensure

  • Board certified by the American Board of Psychiatry

  • Demonstrated understanding of the clinical application of the principles of engagement, empowerment, rehabilitation, and recovery

  • Knowledge of post-acute care planning such as home care, discharge planning, case management, and disease management

  • Computer and typing proficiency, data analysis experience, and solid organizational skills

  • Estimated travel up to 25%

Preferred Qualifications:

  • 5+ years of clinical experience post residency

  • 2+ years of managed care experience

  • Experience in managing BH Services including mental health and substance use disorders

  • Experience working with community-based programs and resources

  • Understanding of the Behavioral Health system of care, the services available, and the criteria for receiving services

Careers with Optum. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges.

California, Colorado, Connecticut, Nevada, New York, Rhode Island, or Washington Residents Only: The salary range for California, Colorado, Connecticut, Nevada, New York, Rhode Island or Washington residents is $363,459 to $574,956. Salary Range is defined as total cash compensation at target. The actual range and pay mix of base and bonus is variable based upon experience and metric achievement. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

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.

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.