Clinical Appeals Consultant (MD)

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. 

Positions in this family include those responsible for functions in areas such as health services, clinical services and delivery of clinical care. Position in this function includes those responsible for management and administration of multiple Medical & Clinical Operations Functions, or managing general operations which are not specific to one of the functions in the Medical & Clinical Operations job family.

Provides leadership to and is accountable for the performance of managers and/or senior level professional staff. Impact of work is most often at the operational or local business unit or market level.

Owns an end-to-end process. Develops functional, market level, and/or site strategy, plans, production and/or organizational priorities. Identifies and resolves technical, operational and organizational problems outside own team. Product, service or process decisions are most likely to impact entire functions and/or customer accounts.

Engage members either face to face or over the phone to have a discussion about their health -Review available member service records and relevant documentation (e.g., utilization history, functional level, stratification information, current plan of care). Conduct comprehensive member assessment that includes bio-psychosocial, functional, and behavioral health needs. Utilize interviewing techniques and active listening to collect and retain member information and incorporating responses as they are presented to complete assessment

Qualifications:

•        Active Medical License/Physician/Medical Director.
•        Experience in BPO/Call Center is an advantage.
• Minimum of 5 years of experience in operations management or a similar role.
• Proven track record of building and leading high-performing teams.
• Strong analytical and problem-solving skills.
• Excellent communication, interpersonal, and organizational skills.
• Willing to work in US Shift and report in any of the sites.
• Onsite work

• Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so