Remote Medical Director, Clinical Coverage & Policy

RXinsider LTD.; Houston (TX); Remote; USD 249,000 - 373,000; Full time

Benefits offered by this job

Comprehensive benefits package

Equity stock purchase

401k contribution

Job summary

UnitedHealth Group in the U.S. seeks a Medical Director to lead physician support and clinical coverage reviews within Enterprise Clinical Services.

You will apply clinical knowledge to benefit determinations, ensure medical necessity, and collaborate with network and non-network physicians to deliver cost-effective, high-quality care. This remote role lets you work from anywhere in the country, partnering with a multidisciplinary team to document findings, communicate outcomes, and support

Qualifications

• MD or DO with unrestricted license to practice medicine.
• 3+ years of clinical practice after residency.
• Board certification in an ABMS specialty; Internal Medicine or Family Medicine preferred.
• Demonstrated understanding of Evidence Based Medicine.
• Proficient PC skills: Word, Outlook, Excel.

Responsibilities

• Conduct coverage reviews based on member benefits and review policies, render determinations.
• Document clinical review findings in accordance with policies and regulations.
• Engage with requesting providers in peer-to-peer discussions.
• Interpret benefit language and policies for clinical coverage reviews.
• Collaborate with network and non-network providers to determine plan benefits.
• Collaborate with internal partners.
• Call coverage rotation.

Skills

Evidence Based Medicine

Clinical Practice

MS Word / Outlook / Excel

Education

MD/DO degree

Tools

MS Word

Outlook

Excel

Job description

UnitedHealth Group in the U.S. seeks a Medical Director to lead physician support and clinical coverage reviews within Enterprise Clinical Services.

You will apply clinical knowledge to benefit determinations, ensure medical necessity, and collaborate with network and non-network physicians to deliver cost-effective, high-quality care. This remote role lets you work from anywhere in the country, partnering with a multidisciplinary team to document findings, communicate outcomes, and support