Remote Medical Director - ENT/Otolaryngology Leadership

UnitedHealth Group; Phoenix (AZ); Remote; USD 249,000 - 373,000; Full time

Benefits offered by this job

Remote work from anywhere in the U.S.

Comprehensive benefits package

Incentive and recognition programs, 4-

Job summary

UnitedHealth Group is seeking a Medical Director to lead the focus claims review program and oversee medical services quality. You will coordinate with physicians and providers, and help shape policies and criteria for medical programs and services.

The role allows remote work from anywhere in the United States and requires strong clinical leadership, regulatory knowledge, and collaboration with payers and staff to ensure medical necessity decisions.

Qualifications

• MD or DO license active and unrestricted.
• Board certification through ABMS or AOA in Otolaryngology (ENT).
• 5+ years of clinical experience after residency.
• MS Office (MS Word, Excel, and Power Point)

Responsibilities

• Reviews surgical and other professional claims for correct coding using clinical records.
• Participation in Training regarding URAC, NCQA, Regulatory Compliance, Confidentiality, Conflict of Interest, HIPAA, and department specific training as applicable
• Discusses cases and clinical coding situations with treating providers telephonically during scheduled hours
• Participates in periodic clinical conferences / calls and in ongoing internal performance consistency reviews
• Composes, if needed, patient situation specific, clinical summaries and rationales for medical necessity decisions
• Supports compliance with regulatory agency standards and requirements (e.g., CMS, NCQA, URAC, state / federal and third-party payers)
• Provide Clinical support for staff that conduct initial reviews

Skills

5+ years clinical experience

Education

MD or DO degree

ABMS or AOA board certification in ENT

Tools

MS Office (Word, Excel, PowerPoint)

Job description

UnitedHealth Group is seeking a Medical Director to lead the focus claims review program and oversee medical services quality. You will coordinate with physicians and providers, and help shape policies and criteria for medical programs and services.

The role allows remote work from anywhere in the United States and requires strong clinical leadership, regulatory knowledge, and collaboration with payers and staff to ensure medical necessity decisions.