Remote Medical Director - DME & Utilization Management

Tnafp; Phoenix, Northern (AZ, KY); Hybrid; USD 249,000 - 373,000; Full time

Job summary

Optum, a global health services leader, seeks a Medical Director to provide physician support within Enterprise Clinical Services. You will apply clinical knowledge to pre-service benefit determinations, collaborating with network and non-network physicians to ensure cost-effective, high-quality care.

This remote role allows work from anywhere in the U.S. and requires MD/DO, board certification, and at least 3 years post-residency.

Qualifications

• MD or DO with an active unrestricted license.
• Board certification in Physical Medicine & Rehabilitation, Internal Medicine, Emergency or Family Medicine.
• 3+ years of clinical practice after residency.
• Solid understanding of Evidence Based Medicine.

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
• Call coverage rotation

Job description

Optum, a global health services leader, seeks a Medical Director to provide physician support within Enterprise Clinical Services. You will apply clinical knowledge to pre-service benefit determinations, collaborating with network and non-network physicians to ensure cost-effective, high-quality care.

This remote role allows work from anywhere in the U.S. and requires MD/DO, board certification, and at least 3 years post-residency.