Remote Medical Director, General Surgery Claims

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

Benefits offered by this job

Remote work from anywhere in the U.S.

Job summary

Optum is seeking a Medical Director to lead the Focus Claims Review team, providing oversight for medical services and quality of claim reviews. You will liaise with physicians and providers, ensuring adherence to policies and clinical criteria while supporting staff in initial reviews.

The role offers remote work from anywhere in the United States and requires board certification, an active license, and extensive clinical experience.

Qualifications

• MD or DO with active medical license.
• Board certification through ABMS or AOA in General Surgery.
• 5+ years of clinical experience after residency.
• MS Office proficiency (Word, Excel, PowerPoint).

Responsibilities

• Reviews surgical and other professional claims for correct coding using clinical records.
• Participates in training on URAC, NCQA, regulatory compliance, confidentiality, conflicts of interest, HIPAA, and related training.
• Discusses cases and clinical coding with treating providers via teleconference during scheduled hours.
• Participates in periodic clinical conferences, calls, and internal performance reviews.
• Drafts patient-specific clinical summaries and rationales for medical necessity when needed.
• Supports compliance with regulatory standards and third-party payers.
• Provides clinical support for staff conducting initial reviews.

Skills

MD or DO

Board certification (ABMS/AOA)

5+ years clinical experience

Education

MD or DO degree

Tools

MS Word

Excel

PowerPoint

Job description

Optum is seeking a Medical Director to lead the Focus Claims Review team, providing oversight for medical services and quality of claim reviews. You will liaise with physicians and providers, ensuring adherence to policies and clinical criteria while supporting staff in initial reviews.

The role offers remote work from anywhere in the United States and requires board certification, an active license, and extensive clinical experience.