Remote ENT Medical Director – Claims & Compliance

UnitedHealth Group; Dallas (TX); Remote; USD 249,000 - 373,000; Full time

Benefits offered by this job

Comprehensive benefits

Incentive programs

Equity stock purchase

401k contribution

Job summary

UnitedHealth Group’s Optum division seeks a Medical Director to lead the Focus Claims Review program, guiding medical services and policies for claim reviews and provider interactions. The role supports remote work nationwide in the U.S. and requires ABMS/AOA ENT certification, MD/DO license, and 5 years of post-residency experience.

Strong communication and MS Office skills are essential. The position offers a competitive salary with comprehensive benefits and opportunities for leadership

Qualifications

• MD or DO with active medical license.
• ABMS/AOA board certification in Otolaryngology (ENT).
• Minimum 5 years of clinical experience post residency.
• Proficient MS Office (Word, Excel, PowerPoint).

Responsibilities

• Reviews surgical and other professional claims for correct coding.
• Participates in training on URAC, NCQA, HIPAA, and related topics.
• Discusses cases with treating providers by telephone during scheduled hours.
• Participates in clinical conferences and ongoing performance reviews.
• Composes clinical summaries and rationales for medical necessity decisions.
• Supports compliance with CMS, NCQA, URAC and other standards.
• Provides clinical support for staff conducting initial reviews.

Skills

Interpersonal skills

Telephone communication

MS Office

Education

MD or DO with medical license

ABMS/AOA ENT board certification

Job description

UnitedHealth Group’s Optum division seeks a Medical Director to lead the Focus Claims Review program, guiding medical services and policies for claim reviews and provider interactions. The role supports remote work nationwide in the U.S. and requires ABMS/AOA ENT certification, MD/DO license, and 5 years of post-residency experience.

Strong communication and MS Office skills are essential. The position offers a competitive salary with comprehensive benefits and opportunities for leadership