Remote Medical Director, General Surgery - Claims & Policy

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

Job summary

Optum, a part of UnitedHealth Group, is seeking a Medical Director to lead the Focus Claims Review team, ensuring high-quality medical services and policy development. The role involves provider discussions, clinical summaries, and regulatory compliance oversight.

The position supports remote work from anywhere in the U.S. and requires an MD or DO with an active license, ABMS/AOA board certification in General Surgery, and 5+ years of clinical experience.

Qualifications

• MD or DO with a current, active, and fully unrestricted medical license.
• Board certification through the American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA) in General Surgery.
• 5+ years of clinical experience post residency.
• MS Office (MS Word, Excel, and Power Point)

Responsibilities

• Reviews surgical and other professional claims for correct coding using clinical record.
• 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.

Education

MD or DO license

ABMS/AOA General Surgery board certification

Tools

MS Office

Job description

Optum, a part of UnitedHealth Group, is seeking a Medical Director to lead the Focus Claims Review team, ensuring high-quality medical services and policy development. The role involves provider discussions, clinical summaries, and regulatory compliance oversight.

The position supports remote work from anywhere in the U.S. and requires an MD or DO with an active license, ABMS/AOA board certification in General Surgery, and 5+ years of clinical experience.