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Optum Associate Medical Director, Beaver Medical Group - Optum in Redlands, California

The Associate Medical Director is responsible for many Medical Management functions that including but not limited to Utilization Management and Quality Management functions. The Associate Medical Director is also responsible for working with physicians and other providers to improve the quality, affordability, and member satisfaction.

Primary Responsibilities:

  • Provides utilization management for outpatient medical, surgical and pharmacy activity.

  • Participates in medical appeals activity. May be asked to review 2nd-level overturned cases related to medical necessity/investigational issues in the context of potential medical policy updates.

  • Works with the Appeals unit 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).

  • Collaborates and engages with the physicians and practices in order to implement strategies to improve the completion rate of annual wellness visits.

  • Collaborates with the Quality team and physicians and practices to implement strategies to improve Quality STARs measures.

About Us

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. Optum brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Here you’ll find incredible ideas in one incredible company and a singular opportunity to do your life's best work.(SM)

Diversity creates a healthier atmosphere: Optum and its affiliated medical practices are Equal Employment Opportunity/Affirmative Action employers 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. Optum and its affiliated medical practices is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.