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Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
Primary Responsibilities:
Provide consistent high-quality DRG-based clinical reviews within the Optum Enterprise Innovative DRG Clinical Review program and be an excellent written and spoken communicator (e.g. communication letters engagement in peer-to-peer conversations)
Close collaboration with a team of medical directors nurse coders and operations team to deliver DRG Clinical Review performance
Identifying opportunities expand and optimize program success in collaboration with other programs such as hospital utilization management and claims adjudication teams
Collaborate with IT partners to implement AI enhancements within programs
Participate in other Value Innovation programs as assigned
Change Management
Participate in the cross collaboration with regional care delivery organizations through OH and Payment Integrity
Closely partner with IT on development and implementation of program delivery
Emotional Maturity and EQ
Establishing strong and lasting trust-based relationships within team and external partners
Foster exemplary teamwork and strengthen a culture of continuous improvement and accountability
Take initiative and self-start attitude to approach problems with energy and passion
Demonstrate preference for working in a tight-knit team environment with diverse professional groups
Youll 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:
M.D. or D.O. with an active unrestricted medical license
Board certified in adult primary care fields (e.g. Internal Medicine Family Medicine Hospitalist) or related subspecialties
3 years of clinical experience post residency
Preferred Qualification:
Experience with DRG clinical documentation and/or coding team collaboration within a hospital system or payor
Experience in chart review (DRG UM PA) or prior role as hospital physician advisor
Employment Type
Full-Time
