Remote Medical Director, Clinical Coverage & Benefits

Texas Health Institute; Los Angeles, Northern (CA, KY); Hybrid; USD 249,000 - 373,000; Full time

Job summary

UnitedHealth Group’s Optum seeks a Medical Director to provide physician support for Enterprise Clinical Services. You will lead pre-service benefit determinations, collaborate with network and non-network physicians, and ensure cost-effective, high-quality care. Remote work nationwide within the U.S.

is available. You will apply clinical knowledge to utilization management, document findings, and communicate across internal teams while promoting evidence-based review and compliant policy

Qualifications

• MD or DO with active, unrestricted medical license.
• Board certification in an ABMS specialty; Internal Medicine or Family Medicine preferred.
• 3+ years of clinical practice after residency.
• Proven understanding of Evidence-Based Medicine (EBM).

Responsibilities

• Conduct coverage reviews based on member plan benefits and policies; render coverage determinations.
• 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 during clinical coverage reviews.
• Communicate with network and non-network providers to ensure accurate determinations for plan participants.
• Collaborate with internal partners during the review process.
• Handle call coverage rotation as needed.

Skills

EBM

Clinical decision making

Education

MD or DO

Tools

MS Word

Outlook

Excel

Job description

UnitedHealth Group’s Optum seeks a Medical Director to provide physician support for Enterprise Clinical Services. You will lead pre-service benefit determinations, collaborate with network and non-network physicians, and ensure cost-effective, high-quality care. Remote work nationwide within the U.S.

is available. You will apply clinical knowledge to utilization management, document findings, and communicate across internal teams while promoting evidence-based review and compliant policy