Remote Chief Medical AI Innovation & UM Performance

Sacbar; Minnetonka, Northern (MN, KY); Hybrid; USD 387,000 - 580,000; Full time

Benefits offered by this job

Comprehensive benefits package

Job summary

UnitedHealthcare seeks a Medical Director, Clinical AI Innovation and Performance to lead clinical annotation, model training, testing and surveillance for utilization management. You will shape evidence-based criteria and govern AI-enabled decision support across enterprise operations.

This senior leadership role focuses on Prior Authorization and inpatient level of care, collaborating with the CMO, Medical Policy and data science to guide clinicians and analysts in scalable decision processes.

Qualifications

• MD or DO with active/unrestricted U.S. Medical Licensure
• Board certification in an ABMS/AOBMS Clinical specialty
• Significant experience in utilization management
• Experience with InterQual clinical criteria
• Experience leading clinical and operational teams in large organizations

Responsibilities

• InterQual Expertise, Interpretation & Guideline Enhancement
• Maintain deep expertise in InterQual criteria and decision logic for UM
• Lead guideline clarification and enhancement to improve clinical clarity and reduce ambiguity
• Develop evidence-based UM criteria aligned with medical policy
• Coordinate with Medical Policy and data teams to translate policy into UM criteria
• UM Operations & Coverage Interpretation Leadership
• Ensure UM criteria function effectively in production to support timely coverage decisions
• Collaborate with UM Operations and Nursing leadership to address operational feedback
• Clinical Annotation & LLM Training for UM
• Oversee clinical annotation and training supporting AI-enabled UM decisions
• Ensure accurate interpretation of UM criteria by LLMs and clinical documentation alignment
• AI Lifecycle Participation & Governance (UCS Led)
• Contribute clinical judgment across AI lifecycle stages and governance processes
• Identify training or safeguards required for AI-enabled workflows
• Cross Functional Clinical Leadership & Continuous Improvement
• Lead clinical annotators and UM analysts; collaborate with policy and product teams
• Drive continuous improvement from production insights to guideline updates

Skills

InterQual expertise

Evidence-based UM criteria

AI/LLM training oversight

Clinical governance

Leadership

Education

MD or DO with active US medical license

Job description

UnitedHealthcare seeks a Medical Director, Clinical AI Innovation and Performance to lead clinical annotation, model training, testing and surveillance for utilization management. You will shape evidence-based criteria and govern AI-enabled decision support across enterprise operations.

This senior leadership role focuses on Prior Authorization and inpatient level of care, collaborating with the CMO, Medical Policy and data science to guide clinicians and analysts in scalable decision processes.