National Medical Director, M.D. or D.O. - Remote

About the position

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. You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. Working Eastern Time Zone business hours is required. As the National Medical Director, you will be a clinical thought leader who develops a clinical value proposition focused on quality and partners with health plan leaders to promote evidence-based medical care that is efficient, effective, and satisfying for members and providers for all Medicaid clients for OptumRx. You will maintain a solid working knowledge of all government mandates and provisions for the local markets, as well as work across the enterprise to implement and maintain compliance clinical programs and procedures. In this role, you will deliver the clinical value proposition focused on quality, affordability, and service, in support of growth activities. You will review and edit communications materials as required and represent the voice of the market-based customer in program design. Additionally, you will contribute to any RFP/re-procurement activity as appropriate. Embracing and supporting a positive and inclusive workplace is essential, as is traveling to participate in P&T committee meetings and DUR board meetings, providing clinical expertise and presenting materials. You will work collaboratively with pharmacists to develop and review new drug reviews, providing clinical oversight and guidance. Your expertise will be crucial in analyzing the clinical and financial implications of changes in Preferred Drug List discussions. You will also oversee clinical prior authorization activities for pharmacy benefit services and engage with requesting providers in peer-to-peer discussions. Being knowledgeable in interpreting existing benefit language and policies during clinical coverage reviews is vital. As a highly effective communicator, you will collaborate with external and internal partners, including executives supporting the Medicaid plans.

Responsibilities
? Develop clinical value proposition focused on quality and partner with health plan leaders to promote evidence-based medical care for Medicaid clients.
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? Maintain knowledge of government mandates and provisions for local markets and implement compliance clinical programs.
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? Deliver clinical value proposition in support of growth activities and represent market-based customer voice in program design.
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? Review and edit communications materials as required and contribute to RFP/re-procurement activities.
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? Support a positive and inclusive workplace culture.
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? Travel to participate in P&T committee meetings and DUR board meetings, providing clinical expertise and presentations.
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? Collaborate with pharmacists to develop and review new drug reviews, providing clinical oversight.
,
? Analyze clinical and financial implications of changes in Preferred Drug List discussions.
,
? Oversee clinical prior authorization activities for pharmacy benefit services and engage in peer-to-peer discussions with providers.
,
? Interpret existing benefit language and policies during clinical coverage reviews.
,
? Collaborate with external and internal partners, including executives supporting Medicaid plans.

Requirements
? Successful completion of a medical residency.
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? Active and unrestricted M.D or D.O. license to practice medicine.
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? Board certification in an ABMS specialty.
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? 5+ years of clinical practice experience after completing residency training.
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? Proven experience in working within a PBM or Health Plan with exposure to pharmacy benefit services management.
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? Proven experience with analysis of Evidence Based Medicine (EBM) research related data analysis.
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? Proven experience in formal presentation for both clinical and non-clinical audiences.
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? Proven solid PC skills, specifically using MS Word, Outlook, Power Point, and Excel.
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? Willing or ability to travel to support in person meetings for 50% of time.

Nice-to-haves
? Hematology Oncology, Psychiatry, or Infectious Disease specialist.
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? Experience in Medicaid line of business.
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? Participation in clinical practice.
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? Experience with P&T committee meetings and DUR board meetings.

Benefits
? Comprehensive benefits package
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? Incentive and recognition programs
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? Equity stock purchase
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? 401k contribution

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