Remote Medical Director - Claims & Coverage Strategy

Optum; Atlanta (GA); On-site; USD 249,000 - 373,000; Full time

Job summary

Optum in Atlanta, GA seeks a Medical Director to provide physician support for Enterprise Clinical Services, focusing on coverage determinations and quality improvement. You will collaborate with network and non-network physicians to ensure cost-effective, evidence-based care.

The role requires an MD or DO, active license, board certification, and 5+ years of clinical practice, with strong data analysis and policy skills. Remote work adherence may apply.

Qualifications

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

Responsibilities

• Conduct coverage reviews based on member plan benefits and policies
• Document clinical review findings, actions, and outcomes per policies and regulations
• Engage with requesting providers in peer-to-peer discussions as needed
• Interpret benefit language and policies in clinical reviews
• Participate in daily clinical rounds as requested
• Communicate with network and non-network providers to ensure timely determinations and educate on plans and policy

Skills

MS Word

Outlook

Excel

Education

M.D. or D.O.

Board certification ABMS or AOA

Job description

Optum in Atlanta, GA seeks a Medical Director to provide physician support for Enterprise Clinical Services, focusing on coverage determinations and quality improvement. You will collaborate with network and non-network physicians to ensure cost-effective, evidence-based care.

The role requires an MD or DO, active license, board certification, and 5+ years of clinical practice, with strong data analysis and policy skills. Remote work adherence may apply.