Remote Medical Director: Clinical Coverage & Utilization

Sustainable World, Inc.; Los Angeles, Northern (CA, KY); Hybrid; USD 249,000 - 373,000; Full time

Job summary

UnitedHealth Group in the United States seeks a Medical Director to provide physician support for Enterprise Clinical Services, focusing on pre-service benefit and coverage determinations. You will collaborate with leadership to maintain clinical and operational processes and ensure cost-effective, high-quality care for members.

The role emphasizes utilization management, peer discussions with physicians, and clear communication across network and non-network providers, with remote work

Qualifications

• MD or DO with active medical license
• ABMS board certification in a specialty; Internal Medicine or Family Medicine preferred
• 3+ years of clinical practice after residency
• Solid understanding of Evidence Based Medicine (EBM)
• Proficient PC skills: MS Word, Outlook, Excel

Responsibilities

• Conduct coverage reviews based on member plan benefits and review policies; render coverage determinations
• Document clinical review findings, actions and outcomes per policies and regulatory requirements
• Engage with requesting providers in peer-to-peer discussions as needed
• Interpret benefit language and policies in clinical coverage reviews
• Communicate with network and non-network providers to ensure accurate determinations and educate on plans
• Collaborate with internal partners and participate in coverage rotation

Skills

Evidence Based Medicine

Communication skills

Clinical practice

Education

MD or DO

ABMS board certification

Tools

MS Word

Outlook

Excel

Job description

UnitedHealth Group in the United States seeks a Medical Director to provide physician support for Enterprise Clinical Services, focusing on pre-service benefit and coverage determinations. You will collaborate with leadership to maintain clinical and operational processes and ensure cost-effective, high-quality care for members.

The role emphasizes utilization management, peer discussions with physicians, and clear communication across network and non-network providers, with remote work