Director, Medical Management - SCPMCS

Optum CA is seeking a Director, Medical Management - SCPMCS to join our team in San Diego, CA. Optum is a clinician-led care organization that is changing the way clinicians work and live.

As a member of the Optum Care Delivery team, you'll be an integral part of our vision to make healthcare better for everyone.

At Optum, you'll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Here, you'll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together.

Join Southern California Physicians Managed Care Services (SCPMCS), a part of Optum
Are you passionate about supporting quality patient care while excelling in a dynamic, physician-governed environment? Since 1996, SCPMCS has been a trusted partner for physician groups across San Diego, providing fully delegated, managed care administrative and management services. Our commitment to excellent client service, advanced technology, and experienced staff allows our clients to focus on what they do best - caring for patients.

Work schedule is 10 hour days/4 days a week.

Why SCPMCS?

• Physician-Governed: We are led by physicians who understand the needs of healthcare providers.
• Fully Delegated: We handle the complexities of managed care, so you don't have to.
• Independent & Not-for-Profit: Our focus is on delivering value, not profits.
• HIPAA Compliant: We prioritize the security and privacy of patient information.
• Dedicated to Growth: We help our clients grow their businesses and succeed.

General Role Description:

Ensure quality health care services are provided to our clients and members, providing oversight to the quality management, utilization management and credentialing functions of the organization.

Primary Responsibilities:

• Develop, implement, and update medical management programs (utilization management, case management, quality improvement, credentialing, member/provider appeals) to stay current with healthcare trends and legislative requirements
• Oversee department operations for quality management, including credentialing, member/provider appeals, utilization management (inpatient, outpatient, high-risk case management), and maintain positive relationships with Medical Directors, Health Plan Representatives, Senior Team, and Clients
• Maintain Client's delegated status for utilization management and credentialing with all contracted health plans; review and assist in negotiating health plan delegation agreements annually
• Develop, review, and revise departmental policies and procedures annually to ensure legislative and regulatory compliance
• Collaborate with Senior Team members and SCPMCS department managers to deliver high-quality MSO services

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:

• BA/BS
• Current unrestricted California Registered Nurse licensure. Reliable transportation, valid California Driver's license and proof of insurance
• 3+ years of experience at a senior level in medical management, specifically in a managed care, health plan, or medical group setting

Preferred Qualification:

• Master's Level

The salary range for this role is $124,500 to $239,400 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.

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.

Diversity creates a healthier atmosphere: OptumCare is an 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

OptumCare is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.