Remote Medical Director: Clinical Coverage & Impact

Optum; Los Angeles (CA); On-site; USD 249,000 - 373,000; Full time

Job summary

Optum is a global health services organization delivering care aided by technology to improve health outcomes. The Medical Director role supports Enterprise Clinical Services with clinical coverage determinations and medical necessity decisions.

The position emphasizes collaboration with network and non-network physicians and requires an MD or DO with board certification and a valid license. Remote work from anywhere in the U.S. is available.

Qualifications

• MD or DO with active, unrestricted medical license.
• Board certification in ABMS specialty; Internal Medicine or Family Medicine preferred.
• Minimum of 3 years clinical practice after residency.
• Strong understanding of Evidence Based Medicine (EBM).
• Proficient with MS Word, Outlook and Excel.

Responsibilities

• Conduct coverage reviews based on member plan benefits and policies.
• Document clinical findings and outcomes per policies and regs.
• Engage with requesting providers in peer-to-peer discussions.
• Interpret benefit language and policies for clinical reviews.
• Collaborate with network and non-network providers for timely determinations.
• Participate in coverage rotation.

Skills

MD/DO

Active license

Board certification (ABMS)

Clinical practice 3+ years

Evidence Based Medicine (EBM)

MS Word/Outlook/Excel

Education

MD/DO degree

Job description

Optum is a global health services organization delivering care aided by technology to improve health outcomes. The Medical Director role supports Enterprise Clinical Services with clinical coverage determinations and medical necessity decisions.

The position emphasizes collaboration with network and non-network physicians and requires an MD or DO with board certification and a valid license. Remote work from anywhere in the U.S. is available.