Medical Director - Clinical Advocacy and Support - Hawaii preferred - Remote

Lensa; Portland (OR); Remote; USD 238,000 - 358,000; Full time

Job summary

An established industry player is seeking a Medical Director for Clinical Advocacy and Support, ideally located in Hawaii but open to remote candidates across the U.S. This role focuses on improving health outcomes through effective clinical reviews and collaboration with healthcare providers. You will lead a multidisciplinary team, ensuring cost-effective and quality medical care while engaging in meaningful peer discussions. With a competitive salary range and comprehensive benefits, this position offers a unique opportunity to make a significant impact on health equity and patient care. Join us to help shape the future of healthcare delivery.

Benefits

Comprehensive Benefits Package

Incentives

Stock Purchase Options

401k Contributions

Qualifications

• 3+ years of clinical practice post-residency required.
• Active unrestricted medical license is mandatory.
• Board certification in Internal Medicine preferred.

Responsibilities

• Conduct coverage reviews based on member benefits and policies.
• Engage with providers in peer-to-peer discussions as needed.
• Document clinical review findings per policies and regulations.

Skills

Evidence-Based Medicine (EBM)

Clinical Practice

Communication Skills

Data Analysis

Problem-Solving

Education

M.D. or D.O.

Board Certification in ABMS Specialty

Tools

MS Word

MS Outlook

MS Excel

Job description

Medical Director - Clinical Advocacy and Support - Hawaii preferred - Remote

2 days ago Be among the first 25 applicants

Lensa is the leading career site for job seekers at every stage of their career. Our client, UnitedHealth Group, is seeking professionals. Apply via Lensa today!

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.

Clinical Advocacy & Support has an unrelenting focus on the customer journey and exceeding expectations in delivering clinical coverage and medical claims reviews. Our role is to empower providers and members with the tools and information needed to improve health outcomes, reduce care variation, deliver seamless experiences, and manage healthcare costs.

The Medical Director provides physician support to Enterprise Clinical Services operations, responsible for initial clinical review of service requests. The Medical Director collaborates with leadership and staff to establish, implement, support, and maintain clinical and operational processes related to benefit coverage determinations, quality improvement, and cost-effectiveness of services for members. The activities focus on applying clinical knowledge in utilization management, especially pre-service benefit and coverage determination or medical necessity, and communicating with network and non-network physicians about this process.

The Medical Director works with a multidisciplinary team and manages medical benefits, often involving primary care or specialist physicians, to ensure the delivery of appropriate, cost-effective, quality medical care.

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities

1. Conduct coverage reviews based on member benefits and policies, render coverage determinations.
2. Document clinical review findings, actions, and outcomes per policies and regulations.
3. Engage with requesting providers in peer-to-peer discussions as needed.
4. Interpret existing benefit language and policies during clinical reviews.
5. Participate in virtual daily clinical rounds if requested.
6. Communicate and collaborate with providers and internal partners to ensure accurate and timely benefit determinations, educating providers on benefit plans and policies.
7. Manage call coverage rotation.

You’ll be rewarded and recognized for your performance in an environment that challenges you, provides clear success criteria, and offers development opportunities.

Required Qualifications

• M.D. or D.O.
• Active unrestricted medical license.
• Board certification in an ABMS specialty; Internal Medicine preferred but others considered.
• 3+ years of clinical practice post-residency.
• Understanding of Evidence-Based Medicine (EBM).
• Proven proficiency with MS Word, Outlook, and Excel.

Preferred Qualifications

• Hawaii residence and license preferred, but other locations/licenses considered.
• Experience in utilization and clinical coverage review.
• Excellent communication, facilitation, data analysis, and presentation skills.
• Innovative problem-solving abilities.

The salary range is $238,000 to $357,500 annually, based on experience and metrics. Benefits include comprehensive packages, incentives, stock purchase options, and 401k contributions. The application deadline is a minimum of 2 business days or until a sufficient candidate pool is reached.

Our mission is to help people live healthier lives and make the health system work better for everyone. We are committed to health equity, environmental sustainability, and eliminating barriers to good health, especially for marginalized groups.

UnitedHealth Group is an Equal Employment Opportunity employer and a drug-free workplace. Candidates must pass a drug test before employment.