Remote Medical Director - Clinical Coverage & Care

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

Job summary

UnitedHealth Group seeks a Medical Director to provide physician support within Enterprise Clinical Services, focusing on clinical coverage determinations, quality improvement, and cost-effectiveness for members.

The role collaborates with network and non-network physicians and involves communicating clinical coverage policies and ensuring timely determinations. A MD/DO with an unrestricted license is required.

Qualifications

• MD or DO degree and active unrestricted medical license.
• Board certification in Physical Medicine & Rehabilitation, Internal Medicine, Family Medicine, general surgery, ortho surgery under American board or AOA certifications.
• 5+ years of clinical practice experience after residency training.
• Sound understanding of Evidence Based Medicine (EBM).
• Proficient computer skills: MS Word, Outlook, and Excel.

Responsibilities

• Conduct coverage reviews based on member plan benefits and policies; render coverage determinations.
• Document clinical review findings, actions, and outcomes per policies and regulatory requirements.
• Engage with requesting providers as needed in peer-to-peer discussions.
• Be knowledgeable in interpreting existing benefit language and policies during reviews.
• Participate in daily clinical rounds as requested.
• Communicate and collaborate with network and non-network providers to ensure accurate and timely determinations.

Skills

Evidence Based Medicine

Education

MD or DO

Active medical license

Tools

MS Word

MS Outlook

Excel

Job description

UnitedHealth Group seeks a Medical Director to provide physician support within Enterprise Clinical Services, focusing on clinical coverage determinations, quality improvement, and cost-effectiveness for members.

The role collaborates with network and non-network physicians and involves communicating clinical coverage policies and ensuring timely determinations. A MD/DO with an unrestricted license is required.