Remote Medical Director - DME & Utilization Strategy

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

Benefits offered by this job

Remote work

Benefits package

Equity stock purchase

401k contribution

Job summary

UnitedHealth Group in the United States seeks a Medical Director to provide physician support for Enterprise Clinical Services, overseeing clinical coverage determinations and cost-effective care. This remote role requires MD/DO, board certification, and 3+ years of post-residency experience; strong knowledge of EB Medicine and MS Office; comprehensive benefits and telecommuter policy provided.

You will collaborate with network and non-network physicians, participate in clinical rounds, and

Qualifications

• MD or DO required and active unrestricted license.
• Board certification in Physical Medicine & Rehabilitation, Internal Medicine, Emergency or Family Medicine.
• 3+ years of clinical practice experience after residency.
• Strong understanding of Evidence Based Medicine (EBM).

Responsibilities

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

Skills

Clinical practice

Evidence Based Medicine

Communication skills

Education

MD or DO

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, overseeing clinical coverage determinations and cost-effective care. This remote role requires MD/DO, board certification, and 3+ years of post-residency experience; strong knowledge of EB Medicine and MS Office; comprehensive benefits and telecommuter policy provided.

You will collaborate with network and non-network physicians, participate in clinical rounds, and