Remote Medical Director - General Surgery Claims

ISHE; Minneapolis, Northern (MN, KY); Hybrid; USD 249,000 - 373,000; Full time

Job summary

Optum is seeking a Medical Director to lead the Focus Claims Review team in providing quality medical review services. You will oversee clinical criteria, engage with physicians and providers, and ensure compliance with regulatory standards.

This role offers remote work across the United States and requires a physician with leadership experience and ABMS/AOA board certification. Salary ranges from $248,500 to $373,000 annually, with comprehensive benefits and opportunities for professional

Qualifications

• MD or DO with active medical license.
• ABMS or AOA board certification in General Surgery.
• 5+ years of clinical experience post-residency.
• MS Office proficiency.

Responsibilities

• Review surgical and professional claims for correct coding.
• Discuss cases with treating providers via telephone.
• Lead training on URAC, NCQA, regulatory compliance, confidentiality, HIPAA.
• Provide clinical summaries and rationales for medical necessity decisions.
• Maintain compliance with CMS, NCQA, URAC, state/federal and third-party payers.

Skills

Interpersonal skills

Telephone communication

Clinical decision making

Education

MD or DO

Board certification ABMS/AOA (General Surgery)

Tools

MS Office

Job description

Optum is seeking a Medical Director to lead the Focus Claims Review team in providing quality medical review services. You will oversee clinical criteria, engage with physicians and providers, and ensure compliance with regulatory standards.

This role offers remote work across the United States and requires a physician with leadership experience and ABMS/AOA board certification. Salary ranges from $248,500 to $373,000 annually, with comprehensive benefits and opportunities for professional