Remote Medical Director — Clinical Coverage & Policy

Wellness Health Careers; Houston (TX); Remote; USD 249,000 - 373,000; Full time

Benefits offered by this job

Remote work across U.S.

Job summary

UnitedHealth Group is seeking a Medical Director to provide physician support for Enterprise Clinical Services, focusing on pre-service determinations and medical necessity reviews. Remote work is available across the U.S.

with opportunities to collaborate with network and non-network physicians and cross-functional teams. The role requires an MD/DO, ABMS/AOA board certification, and an active medical license, with 5+ years of clinical experience and strong EBMs and MS Office skills.

Qualifications

• MD or DO degree required.
• Board certification by ABMS or AOA.
• Active unrestricted medical license.
• 5+ years of clinical practice after residency.
• Strong understanding of Evidence Based Medicine (EBM).
• Proficient in MS Word, Outlook and Excel.
• Ability to participate in holiday and call coverage.

Responsibilities

• Conduct coverage reviews based on member plan benefits and policies.
• Document review findings and outcomes per policies and regulations.
• Engage with providers in peer-to-peer discussions.
• Interpret benefit language during clinical reviews.
• Participate in daily clinical rounds as needed.
• Collaborate with network and non-network providers on determinations.
• Support cross-functional partners to ensure timely decisions.

Skills

Clinical practice

Evidence Based Medicine

MS Word

Outlook

Excel

Communication skills

Team collaboration

Education

MD/DO degree

Board certification (ABMS/AOA)

Tools

MS Word

Outlook

Excel

Job description

UnitedHealth Group is seeking a Medical Director to provide physician support for Enterprise Clinical Services, focusing on pre-service determinations and medical necessity reviews. Remote work is available across the U.S.

with opportunities to collaborate with network and non-network physicians and cross-functional teams. The role requires an MD/DO, ABMS/AOA board certification, and an active medical license, with 5+ years of clinical experience and strong EBMs and MS Office skills.