Remote Medical Director — Clinical Coverage & Impact

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

Job summary

UnitedHealth Group's Optum is seeking a Medical Director to provide physician support for Enterprise Clinical Services, guiding clinical coverage reviews and medical necessity determinations. This remote role offers nationwide scope across the U.S.

and requires an MD/DO with an active license, ABMS board certification, and 3+ years of clinical practice to ensure cost-effective, evidence-based care. You will collaborate with network and non-network physicians and internal partners to improve

Qualifications

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

Responsibilities

• Conduct coverage reviews based on member plan benefits and review policies; render determinations.
• Document clinical findings and outcomes per policies and regulatory requirements.
• Engage with requesting providers in peer-to-peer discussions.
• Interpret benefit language and policies during clinical coverage reviews.
• Communicate with network and non-network providers to ensure timely determinations.

Skills

Clinical practice

Evidence Based Medicine

Communication skills

Data analysis

Education

MD or DO

Tools

MS Word

Outlook

Excel

Job description

UnitedHealth Group's Optum is seeking a Medical Director to provide physician support for Enterprise Clinical Services, guiding clinical coverage reviews and medical necessity determinations. This remote role offers nationwide scope across the U.S.

and requires an MD/DO with an active license, ABMS board certification, and 3+ years of clinical practice to ensure cost-effective, evidence-based care. You will collaborate with network and non-network physicians and internal partners to improve