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

Lensa; Seattle (WA); Remote; USD 238,000 - 358,000; Full time

Job summary

A leading career site is seeking a Medical Director for Clinical Advocacy and Support, preferably based in Hawaii but open to remote work. This role involves conducting clinical reviews, collaborating with a multidisciplinary team, and ensuring quality medical care delivery. Candidates must possess an M.D. or D.O. and have board certification with at least 3 years of clinical experience.

Benefits

Comprehensive benefits packages

Incentives and stock purchase options

401k contributions

Qualifications

• At least 3 years of clinical practice experience post-residency.
• Active unrestricted license to practice medicine.
• Internal Medicine preferred; other specialties considered.

Responsibilities

• Conduct coverage reviews based on individual member plan benefits.
• Document clinical review findings and engage with providers.
• Communicate and collaborate with providers for accurate benefit determinations.

Skills

Evidence-Based Medicine

Communication

Data Analysis

Problem Solving

Presentation

Education

M.D. or D.O.

Board certification in an ABMS specialty

Tools

MS Word

Outlook

Excel

Job description

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

1 day 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 ensuring we exceed expectations as we deliver 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 variation in care, deliver seamless experiences, and manage healthcare costs.

The Medical Director provides physician support to Enterprise Clinical Services operations, responsible for the initial clinical review of service requests. The role involves collaborating with leadership to establish, implement, and maintain clinical and operational processes related to benefit coverage, quality improvement, and cost-effectiveness. The activities mainly focus on utilization management, pre-service benefit and coverage determination, and communication with providers regarding these processes.

The Medical Director collaborates with a multidisciplinary team and manages medical benefits, often involving the member’s primary care provider or specialist. The primary responsibility is to ensure the delivery of appropriate, cost-effective, and quality medical care to members.

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

Primary Responsibilities

• Conduct coverage reviews based on individual member plan benefits and policies, and render coverage determinations.
• Document clinical review findings, actions, and outcomes per policies and regulatory requirements.
• Engage with requesting providers in peer-to-peer discussions as needed.
• Interpret benefit language and policies during clinical reviews.
• Participate in virtual daily clinical rounds as requested.
• Communicate and collaborate with providers and internal partners to ensure accurate and timely benefit determinations, educating providers on benefit plans and policies.
• Call coverage rotation.

You’ll be rewarded and recognized for your performance in an environment that challenges you and provides clear development paths.

Required Qualifications

• M.D. or D.O.
• Active unrestricted license to practice medicine.
• Board certification in an ABMS specialty, with Internal Medicine preferred; other specialties like General Surgery, Rheumatology, ER, Family Medicine, ENT, or PM&R will be considered.
• At least 3 years of clinical practice experience post-residency.
• Understanding of Evidence-Based Medicine (EBM).
• Proven PC skills, especially MS Word, Outlook, and Excel.

Preferred Qualifications

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

The salary range is $238,000 to $357,500 annually, based on full-time employment, experience, and achievement metrics. Benefits include comprehensive packages, incentives, stock purchase options, and 401k contributions. The application will be posted for at least 2 business days or until enough candidates are collected.

Our mission is to help people live healthier lives and make the health system work better for everyone. We are committed to health equity and addressing disparities, especially for marginalized groups. We are an Equal Employment Opportunity employer and a drug-free workplace, requiring a drug test prior to employment.