Remote Medical Director - Clinical Coverage

Optum; Houston (TX); Remote; USD 249,000 - 373,000; Full time

Benefits offered by this job

Comprehensive benefits

401k plan

Equity stock purchase

Telecommuter Policy

Job summary

Optum is seeking a Medical Director to provide physician support for Enterprise Clinical Services. The role focuses on clinical coverage determinations, utilization management, and communication with network and non-network physicians to ensure cost-effective care. You can work remotely from anywhere in the U.S.; in Minneapolis or Washington, D.C.

offices may require four days in office. Primary responsibilities include reviews, documentation, peer discussions, and collaboration with partners to

Qualifications

• MD or DO required.
• Active unrestricted license to practice medicine.
• Board certification in Physical Medicine & Rehabilitation, Internal Medicine, Family Medicine, general surgery, ortho surgery under American board or AOA board certifications.
• 5+ years of clinical practice experience after completing residency training.
• Sound understanding of Evidence Based Medicine (EBM).
• Proven solid PC skills, specifically using MS Word, Outlook, and Excel.

Responsibilities

• Conduct coverage reviews and render coverage determinations based on plan benefits and policies.
• Document clinical review findings in compliance with policies and regulations.
• Engage with requesting providers in peer-to-peer discussions as needed.
• Interpret benefit language and policies for clinical coverage reviews.
• Participate in daily clinical rounds as requested.
• Collaborate with network and non-network providers to educate on benefit plans and medical policy.
• Coordinate with internal partners to support timely determinations.
• Manage call coverage rotation.

Skills

Clinical practice experience

Evidence Based Medicine (EBM)

PC skills

Education

MD or DO

Tools

MS Word

Outlook

Excel

Job description

Optum is seeking a Medical Director to provide physician support for Enterprise Clinical Services. The role focuses on clinical coverage determinations, utilization management, and communication with network and non-network physicians to ensure cost-effective care. You can work remotely from anywhere in the U.S.; in Minneapolis or Washington, D.C.

offices may require four days in office. Primary responsibilities include reviews, documentation, peer discussions, and collaboration with partners to