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

Lensa; Waimea (HI); Remote; USD 238,000 - 358,000; Full time

Job summary

A leading healthcare organization is seeking a Medical Director for Clinical Advocacy and Support. This role focuses on improving health outcomes through clinical reviews and collaboration with providers. The position offers remote flexibility and a comprehensive benefits package, including competitive salary and career development opportunities.

Benefits

Comprehensive benefits package

Incentive programs

Stock purchase options

401k contributions

Qualifications

• 3+ years of clinical practice post-residency.
• Active unrestricted medical license required.

Responsibilities

• Conduct coverage reviews and render coverage determinations.
• Document clinical review findings and actions.
• Engage with providers in peer-to-peer discussions.

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

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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 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 experience, 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 Medical Director collaborates with leadership and staff to establish, support, and maintain clinical and operational processes related to benefit coverage determinations, quality improvement, and cost-effectiveness of services. The activities primarily focus on applying clinical knowledge in utilization management, especially pre-service benefit and coverage determinations or medical necessity, and communicating this with network and non-network physicians.

The Medical Director works with a multidisciplinary team and is involved in managing medical benefits, often collaborating with the member’s primary care provider or specialist. The primary responsibility is ensuring the provision 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 challenging responsibilities.

Primary Responsibilities

• Conduct coverage reviews based on member benefits and policies, and render coverage determinations.
• Document clinical review findings, actions, and outcomes according to 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 to ensure accurate and timely benefit determinations, and educate them on benefit plans and policies.
• Collaborate with internal partners.
• Call coverage rotation.

You’ll be rewarded and recognized for your performance in a challenging environment that offers clear development paths.

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 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 other factors. Benefits include a comprehensive package, incentive programs, stock purchase options, and 401k contributions. The application will be open for at least 2 days or until enough candidates are collected.

Our mission is to help people live healthier lives and improve health equity. We are committed to diversity, equity, and inclusion, and to mitigating environmental impact. We are an Equal Employment Opportunity employer and a drug-free workplace.

Additional Details

• Seniority level: Mid-Senior level
• Employment type: Full-time
• Job function: Health Care Provider