Remote Medical Director — Clinical Coverage & Benefits

Optum; United States; Remote; USD 238,000 - 358,000; Full time

Job summary

UnitedHealth Group is seeking a Medical Director to provide physician support to Enterprise Clinical Services operations, focusing on pre-service benefit determinations and medical necessity assessments. You will collaborate with leadership to maintain clinical processes and ensure cost-effective, high-quality care for members.

Remote-friendly role nationwide in the U.S.; in-office requirements apply in Minneapolis or Washington, D.C. with four days on-site per week.

Qualifications

• MD or DO with active unrestricted license to practice medicine.
• Board certification in Physical Medicine & Rehabilitation, Internal Medicine, or Family Medicine.
• 5+ years of clinical practice after residency.
• Knowledge of Evidence Based Medicine (EBM).
• Proficient MS Word, Outlook, Excel.

Responsibilities

• Conduct coverage reviews and render coverage determinations.
• Document clinical review findings in accordance with 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 to ensure timely determinations.

Skills

EBM knowledge

MS Word/Outlook/Excel

Peer-to-peer discussions

Education

MD or DO

Active unrestricted medical license

Board certification in PM&R/IM/FM

Tools

MS Word

Outlook

Excel

Job description

UnitedHealth Group is seeking a Medical Director to provide physician support to Enterprise Clinical Services operations, focusing on pre-service benefit determinations and medical necessity assessments. You will collaborate with leadership to maintain clinical processes and ensure cost-effective, high-quality care for members.

Remote-friendly role nationwide in the U.S.; in-office requirements apply in Minneapolis or Washington, D.C. with four days on-site per week.