Medical Director, Provider Relations - Jacksonville, FL - Full-time / Part-time

Medical Director careers at UnitedHealth Group are anything but ordinary. We push ourselves and each other to find smarter solutions. The result is a culture of performance that's driving the health care industry forward. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Join us. And start doing your life's best work.(sm) 

Primary Responsibilities:

• Assists in development and maintaining an efficient UM program to meet the needs of the health plan members and commensurate with company values


• Educates primary care physicians regarding systems, structures, processes and outcomes necessary for assurance of regulatory compliance related to market activities


• Develops strategies for improving all aspects of market performance including RAPS, membership, and medical management


• Participates in case review and medical necessity determination


• Conducts post service reviews issued for medical necessity and benefits determination coding


• Analyzes aggregate data and reports to primary care physician


• Serves as the liaison between physicians and health plan Medical Directors


• Supervises the functions of Care Coordination


• Assesses the effectiveness of the specialty network to ensure members have access to multi-specialties within their demographic area


• Represents the providers as an influence to the credentialing committee


• Reviews policies and procedures of credentialing department and offers guidance for revision and implementation of process


• Educates primary care network and assists in problem resolution


• Assists in development of medical management protocols


• Performs analysis of utilization data and suggests/implements corrective action plans with network physicians


• Performs all other related duties as assigned 

Customer Service:

• Oversees and insures physician compliance with UM plan


• Evaluates performance of physicians in regards to established goals and objectives of the company


• Performs all duties with physicians and medical group staff in a professional and responsible manner


• Responds to physicians in a prompt, pleasant and professional manner


• Respects physician, patient, and organizational confidentiality


• Educates medical groups regarding UM policies, procedures and government-mandated regulations


• Provides quality assurance and education of current medical technologies, review criteria, accepted practice of medicine guidelines, and UM policies and procedures with counsel when criterion are not met 

Personal and Physician Development:

• Strives to personally expand working knowledge of all aspects of the UM department


• An active participant in physician meetings


• Orients new physicians to ensure understanding of company policy and resources available for physician support


• Encourages teamwork and cooperation with medical group staffs in order to prepare for cross training and float positions


• Assists in the growth and development of subordinates by sharing special knowledge with others and promotes continued education classes


• Attends continuing education classes to keep abreast of medical advancements and innovative practice guidelines

Required Qualifications: 

• Current Florida Medical License


• Doctor of Medicine (M.D.) degree


• Five or more years of clinical practice experience


• Proficiency with Microsoft Office applications

Preferred Qualifications:

• Physician network development and/or provider relationship experience


• Two years of experience working in a managed care health plan environment


• Two or more years of experience in utilization management activities


• Bilingual (English/Spanish) fluency


• Board Certified Family Practitioner or Internal Medical Specialist

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, 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. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.SM

Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability status.



UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.