Remote Medical Director - Clinical Coverage Leader

Sacbar; Phoenix (AZ); Remote; USD 249,000 - 373,000; Full time

Job summary

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The Medical Director provides physician support to Enterprise Clinical Services and collaborates to establish and maintain clinical and operational processes for benefit coverage determinations.

You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you lead clinical reviews, communicate with providers, and guide decision-making to ensure cost-effective,

Qualifications

• MD or DO with active unrestricted license to practice medicine.
• Board certification in Physical Medicine & Rehabilitation, Internal Medicine, Emergency or Family Medicine.
• 3+ years of clinical practice experience after completing residency training.
• Sound understanding of Evidence Based Medicine (EBM).
• Proven proficiency with MS Word, Outlook and Excel.

Responsibilities

• Conduct coverage reviews based on member plan benefits and national and proprietary coverage review policies, render coverage determinations.
• Document clinical review findings, actions, and outcomes in accordance with policies, and regulatory and accreditation requirements.
• Engage with requesting providers as needed in peer-to-peer discussions.
• Be knowledgeable in interpreting existing benefit language and policies in the process of clinical coverage reviews.
• Participate in daily clinical rounds as requested.
• Communicate and collaborate with network and non-network providers in pursuit of accurate and timely benefit determinations for plan participants while educating providers on benefit plans and medical policy.
• Communicate and collaborate with other internal partners.
• Call coverage rotation.

Education

MD or DO

Tools

MS Word

Outlook

Excel

Job description

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The Medical Director provides physician support to Enterprise Clinical Services and collaborates to establish and maintain clinical and operational processes for benefit coverage determinations.

You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you lead clinical reviews, communicate with providers, and guide decision-making to ensure cost-effective,