Remote Medical Director - Orthopedic Surgery Claims

UnitedHealth Group; Nashville (TN); Remote; Confidential; Full time

Job summary

UnitedHealth Group is seeking a Medical Director to lead the Focus Claims Review team. The role oversees medical services, provider discussions, and policy development for medical programs and services. Remote work in the U.S.

is supported with strong emphasis on clinical excellence and regulatory compliance. The position requires an MD/DO, ABMS/AOA board certification in Orthopedic Surgery, and 5+ years of post-residency experience.

Qualifications

• MD or DO with a current, active, and fully unrestricted medical license.
• Board certification through ABMS or AOA in Orthopedic Surgery.
• 5+ years of clinical experience post residency.
• MS Office (Word, Excel, PowerPoint).

Responsibilities

• Reviews surgical and professional claims for correct coding using clinical records.
• Participates in training on URAC, NCQA, regulatory compliance, confidentiality, conflicts of interest, HIPAA.
• Discusses cases with treating providers telephonically during scheduled hours.
• Participates in clinical conferences and internal performance reviews.
• Composes clinical summaries and rationales for medical necessity decisions when needed.
• Supports compliance with regulatory standards (CMS, NCQA, URAC, state/federal, payers).
• Provides clinical support for staff conducting initial reviews.

Skills

Clinical experience

Education

MD or DO with active license

ABMS/AOA board cert in Orthopedic Surgery

Tools

MS Office

Job description

UnitedHealth Group is seeking a Medical Director to lead the Focus Claims Review team. The role oversees medical services, provider discussions, and policy development for medical programs and services. Remote work in the U.S.

is supported with strong emphasis on clinical excellence and regulatory compliance. The position requires an MD/DO, ABMS/AOA board certification in Orthopedic Surgery, and 5+ years of post-residency experience.