Medical Director - Utilization & Policy Lead

RXinsider LTD.; Los Angeles (CA); Remote; USD 249,000 - 373,000; Full time

Benefits offered by this job

Comprehensive benefits

401(k) contribution with equity stock

Job summary

UnitedHealth Group is seeking a physician to conduct coverage reviews based on member plan benefits and established policies. You will document findings and engage with providers in peer-to-peer discussions to ensure timely benefit determinations.

Required: MD or DO with an active license, ABMS board certification in Internal or Family Medicine preferred, and 3+ years of clinical practice. Strong proficiency in MS Word, Outlook, and Excel is expected.

Qualifications

• MD or DO required.
• Active unrestricted license to practice medicine.
• ABMS board certification in Internal Medicine or Family Medicine preferred.
• 3+ years of clinical practice after residency.
• Solid understanding of Evidence Based Medicine (EBM).
• Proficient with MS Word, Outlook and Excel.

Responsibilities

• Conduct coverage reviews based on member plan benefits and policies.
• Document clinical review findings and outcomes per policies and regulations.
• Engage with requesting providers in peer-to-peer discussions.
• Interpret benefit language and policies during clinical reviews.
• Communicate with network and non-network providers to obtain accurate benefit determinations.

Skills

EBM proficiency

Clinical experience

Medical communication

Team collaboration

Education

MD/DO

ABMS board certification (Internal/Family Medicine)

Tools

MS Word

Outlook

Excel

Job description

UnitedHealth Group is seeking a physician to conduct coverage reviews based on member plan benefits and established policies. You will document findings and engage with providers in peer-to-peer discussions to ensure timely benefit determinations.

Required: MD or DO with an active license, ABMS board certification in Internal or Family Medicine preferred, and 3+ years of clinical practice. Strong proficiency in MS Word, Outlook, and Excel is expected.