Remote ENT Medical Director: Claims & Care Quality Leader

UnitedHealth Group; Phoenix (AZ); Remote; USD 249,000 - 373,000; Full time

Benefits offered by this job

Comprehensive benefits package

Incentive and recognition programs

Equity stock purchase plan

401(k) contribution

Job summary

UnitedHealth Group is seeking a Medical Director to lead the Focus Claims Review team, overseeing medical services quality and coordination for claim reviews. The role involves provider discussions, appeals, and policy development with a national scope.

The position offers remote work from anywhere in the U.S., with established training, compliance oversight, and opportunities to contribute to clinical criteria across programs. A competitive salary and comprehensive benefits accompany the role.

Qualifications

• MD or DO with a current, active, and fully unrestricted medical license.
• Board certification through ABMS or AOA in Otolaryngology (ENT).
• 5 years of clinical experience post residency.
• MS Office proficiency (Word, Excel, PowerPoint).

Responsibilities

• Reviews surgical and other professional claims for correct coding using clinical records.
• Participates in training regarding URAC, NCQA, regulatory compliance, confidentiality, conflicts of interest, HIPAA, and department-specific training.
• Discusses cases and clinical coding with treating providers telephonically during scheduled hours.
• Participates in periodic clinical conferences and internal performance reviews.
• Composes clinical summaries and rationales for medical necessity decisions when needed.
• Supports regulatory compliance with standards from CMS, NCQA, URAC, state/federal and third-party payers.
• Provides clinical support for staff conducting initial reviews.

Skills

Interpersonal skills

Telephone communications

Education

MD or DO medical degree

ABMS/AOA ENT board certification

Tools

MS Word

MS Excel

PowerPoint

Job description

UnitedHealth Group is seeking a Medical Director to lead the Focus Claims Review team, overseeing medical services quality and coordination for claim reviews. The role involves provider discussions, appeals, and policy development with a national scope.

The position offers remote work from anywhere in the U.S., with established training, compliance oversight, and opportunities to contribute to clinical criteria across programs. A competitive salary and comprehensive benefits accompany the role.