Remote Medical Director - Claims & Coverage Review

UnitedHealth Group; Atlanta (GA); Remote; USD 249,000 - 373,000; Full time

Job summary

UnitedHealth Group seeks a Medical Director to provide physician support for Enterprise Clinical Services. The role focuses on clinical guidance for benefit coverage determinations, quality improvement, and cost-effective patient care.

Remote work is available nationwide in the U.S. Responsibilities include conducting coverage reviews, documenting findings, peer discussions with providers, and collaborating with network and non-network physicians to ensure timely, accurate determinations.

Qualifications

• MD or DO with active unrestricted medical license
• Board certification in Medicine (ABMS or AOA)
• 5+ years of physician clinical practice after residency
• Proven understanding of Evidence Based Medicine (EBM)
• Proficient with MS Word, Outlook and Excel

Responsibilities

• Conduct coverage reviews based on member plan benefits and policies; render coverage determinations
• Document clinical review findings and outcomes per policies and regulatory requirements
• Engage with requesting providers in peer-to-peer discussions
• Interpret existing benefit language and policies during reviews
• Participate in daily clinical rounds as requested
• Collaborate with network and non-network providers to pursue accurate benefit determinations for plan participants

Skills

Evidence Based Medicine

Clinical decision making

Communication skills

Presentation skills

Education

MD/DO

Tools

MS Word

Outlook

Excel

Job description

UnitedHealth Group seeks a Medical Director to provide physician support for Enterprise Clinical Services. The role focuses on clinical guidance for benefit coverage determinations, quality improvement, and cost-effective patient care.

Remote work is available nationwide in the U.S. Responsibilities include conducting coverage reviews, documenting findings, peer discussions with providers, and collaborating with network and non-network physicians to ensure timely, accurate determinations.