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

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

Job summary

A leading healthcare organization seeks a Medical Director for Clinical Advocacy and Support. This remote role involves overseeing clinical reviews and collaborating with multidisciplinary teams to improve health outcomes. Candidates should possess an M.D. or D.O., an active medical license, and board certification. The position offers a competitive salary and comprehensive benefits.

Benefits

Comprehensive benefits

Incentive programs

Stock purchase options

401k contributions

Qualifications

• 3+ years of clinical practice post-residency.
• Understanding of Evidence-Based Medicine (EBM).

Responsibilities

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

Skills

Communication

Data Analysis

Problem-Solving

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

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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 focuses on the customer journey, ensuring we exceed expectations in delivering clinical coverage and medical claims reviews. Our role is to empower providers and members with tools and information to improve health outcomes, reduce care variation, and manage healthcare costs.

The Medical Director provides physician support to Enterprise Clinical Services, overseeing initial clinical review of service requests. The role involves establishing, supporting, and maintaining clinical and operational processes related to benefit coverage, quality improvement, and cost-effectiveness, primarily focusing on pre-service benefit and coverage determination and communication with providers.

The Medical Director collaborates with a multidisciplinary team, often involving primary care or specialist physicians, to ensure appropriate, cost-effective, quality medical care for 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 member benefits and policies, and render determinations.
• Document clinical review findings in compliance with policies and regulations.
• Engage with providers in peer-to-peer discussions as needed.
• Interpret benefit language and policies during clinical reviews.
• Participate in virtual clinical rounds as requested.
• Communicate with providers and internal teams to ensure accurate benefit determinations and educate on benefit plans and policies.
• Call coverage rotation.

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

Required Qualifications

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

Preferred Qualifications

• Hawaii residence/license preferred but not required.
• Experience in utilization and clinical coverage review.
• Excellent communication, facilitation, data analysis, problem-solving, and presentation skills.
• Remote employees must adhere to UnitedHealth Group’s Telecommuter Policy.

The salary range is $238,000 to $357,500 annually, based on full-time employment, experience, and metrics. Benefits include comprehensive packages, incentive programs, stock purchase options, and 401k contributions.

Application Deadline: Minimum 2 business days or until a sufficient candidate pool is reached. Early removal possible due to volume.

Our mission is to help people live healthier lives and improve health equity globally. We are committed to diversity, inclusion, environmental sustainability, and equitable healthcare.

UnitedHealth Group is an Equal Employment Opportunity employer. All qualified applicants will receive consideration regardless of race, gender, age, etc. We are a drug-free workplace requiring a pre-employment drug test.