Remote Medical Director - Claims & Utilization Review

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

Job summary

Optum is seeking a Medical Director to provide physician support for Enterprise Clinical Services, focusing on coverage determinations and medical necessity reviews for plan members. Remote work is available nationwide within the United States, with collaboration across network and non-network providers.

Requirements include an MD or DO, unrestricted license, board certification, and at least five years of clinical practice. Proficiency in MS Word, Outlook, and Excel is expected.

Qualifications

• MD/DO with active unrestricted license; ability to obtain additional state licenses as needed.
• 5+ years of physician clinical practice after residency.
• Demonstrated understanding of Evidence Based Medicine (EBM).
• Proficient PC skills: MS Word, Outlook and Excel.

Responsibilities

• Conduct coverage reviews based on member plan benefits and policies; render determinations.
• Document review findings, actions, and outcomes per policies and regulations.
• Engage with requesting providers in peer-to-peer discussions.
• Interpret benefit language and policies during clinical reviews.
• Participate in daily clinical rounds as requested.
• Collaborate with network and non-network providers for timely determinations.
• Coordinate with internal partners to support care decisions.

Skills

Clinical practice

Evidence Based Medicine

Education

MD/DO

Tools

MS Word

Outlook

Excel

Job description

Optum is seeking a Medical Director to provide physician support for Enterprise Clinical Services, focusing on coverage determinations and medical necessity reviews for plan members. Remote work is available nationwide within the United States, with collaboration across network and non-network providers.

Requirements include an MD or DO, unrestricted license, board certification, and at least five years of clinical practice. Proficiency in MS Word, Outlook, and Excel is expected.