Medical Director, AI-Driven Utilization & Policy

Cim; Minnetonka (MN); Hybrid; USD 387,000 - 580,000; Full time

Benefits offered by this job

Remote work within US

Job summary

UnitedHealthcare is seeking a Medical Director for AI Innovation and Performance to lead clinical annotation, training, and evaluation of UM criteria across the enterprise. You will oversee InterQual-based guideline enhancements and collaborate with policy and data teams to scale safe, evidence-based coverage decisions.

The role involves senior clinical judgment, AI-enabled decision support, and governance participation, with a flexible remote work option within the U.S.

Qualifications

• MD or DO with active/unrestricted U.S. medical licensure.
• Board certification in an ABMS/AOBMS clinical specialty.
• Significant experience in utilization management and coverage interpretation using UM criteria.

Responsibilities

• Lead InterQual criteria interpretation and guideline enhancement for UM.
• Develop evidence-based UM criteria aligned with medical policy.
• Oversee clinical annotation and LLM training for UM decision support.
• Collaborate with Medical Policy, CARES, UM Operations and AI/data teams.
• Participate in AI lifecycle reviews and governance within UCS/UHC.

Skills

Utilization management

Clinical AI

Leadership

InterQual criteria

LLM training & supervision

Education

MD or DO with active U.S. medical licensure

ABMS/AOBMS board certification

Tools

InterQual criteria system

AI governance tools

Job description

UnitedHealthcare is seeking a Medical Director for AI Innovation and Performance to lead clinical annotation, training, and evaluation of UM criteria across the enterprise. You will oversee InterQual-based guideline enhancements and collaborate with policy and data teams to scale safe, evidence-based coverage decisions.

The role involves senior clinical judgment, AI-enabled decision support, and governance participation, with a flexible remote work option within the U.S.