Remote Medical Director – Clinical Coverage & Utilization

Texas Health Institute; Phoenix (AZ); 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 is seeking a Medical Director to provide physician support to Enterprise Clinical Services and oversee clinical coverage reviews and medical necessity determinations. You will collaborate with network and non-network physicians, document findings, participate in clinical rounds, and help guide benefit language interpretation, with flex remote work across the U.S.

This full-time role requires MD/DO, board certification, and 3+ years of practice and offers a comprehensive

Qualifications

• MD or DO with active unrestricted license to practice medicine.
• Board certification in relevant specialty as listed.
• Minimum 3+ years of clinical practice after residency.
• Solid understanding of Evidence Based Medicine (EBM).
• Proficient PC skills including Word, Outlook, and Excel.

Responsibilities

• Conduct coverage reviews based on member benefits and policies.
• Document clinical review findings, actions and outcomes.
• Engage with requesting providers in peer-to-peer discussions.
• Interpret benefit language and policies during reviews.
• Participate in daily clinical rounds as requested.
• Collaborate with network and non-network providers for timely determinations.
• Coordinate with internal partners and participate in coverage rotation.

Skills

Communication skills

Evidence Based Medicine

Education

MD or DO

Active unrestricted medical license

Board certification in Physical Medicine & Rehabilitation, Internal Medicine, Emergency or Family Medicine

Tools

MS Word

Outlook

Excel

Job description

UnitedHealth Group is seeking a Medical Director to provide physician support to Enterprise Clinical Services and oversee clinical coverage reviews and medical necessity determinations. You will collaborate with network and non-network physicians, document findings, participate in clinical rounds, and help guide benefit language interpretation, with flex remote work across the U.S.

This full-time role requires MD/DO, board certification, and 3+ years of practice and offers a comprehensive