Remote Medical Director - Clinical Coverage Optimization

RXinsider LTD.; Northern (KY); Hybrid; USD 249,000 - 373,000; Full time

Benefits offered by this job

Remote work flexibility

Benefits package

Job summary

UnitedHealth Group is seeking a Medical Director for enterprise clinical services with MD/DO credential, board certification, and unrestricted license in NM/AZ. Remote work option available.

Responsibilities include conducting coverage reviews, documenting findings, peer discussions, and collaboration with providers to ensure timely and accurate benefit determinations. The role requires 5+ years of clinical experience, proficiency in MS Word/Outlook/Excel, and ongoing willingness to cover

Qualifications

• MD or DO with current board certification (ABMS or AOA).
• Active unrestricted medical license in NM or AZ.
• 5+ years of clinical practice after residency.
• Strong foundation in Evidence Based Medicine (EBM).
• Proficient MS Word, Outlook and Excel skills.
• Willingness to participate in holiday and on-call coverage.

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.
• Participate in occasional holiday and call coverage rotation.

Skills

Data analysis

Problem solving

Presentation skills

Communication

Education

MD/DO

ABMS/AOA board certification

Tools

MS Word

Outlook

Excel

Job description

UnitedHealth Group is seeking a Medical Director for enterprise clinical services with MD/DO credential, board certification, and unrestricted license in NM/AZ. Remote work option available.

Responsibilities include conducting coverage reviews, documenting findings, peer discussions, and collaboration with providers to ensure timely and accurate benefit determinations. The role requires 5+ years of clinical experience, proficiency in MS Word/Outlook/Excel, and ongoing willingness to cover