Remote Medical Director, Pediatrics & Care Optimization

ISHE; Houston, Northern (TX, KY); Hybrid; USD 249,000 - 373,000; Full time

Benefits offered by this job

Telecommuter Policy

Job summary

UnitedHealth Group is seeking a Medical Director to support Enterprise Clinical Services from a remote location in the U.S. The role focuses on clinical coverage determinations, quality improvement, and cost-effective care, collaborating with network and non-network physicians.

Requirements include MD/DO with ABMS/AOA board certification, active medical license, 5+ years of clinical practice, and strong data and communication skills.

Qualifications

• MD or DO degree required with ABMS/AOA board certification in IM/Peds or Family Medicine.
• Active unrestricted medical license with ability to obtain additional state licenses.
• 5+ years of clinical practice after residency.
• Evidence Based Medicine (EBM) knowledge.
• Proficient PC skills: Word, Outlook, Excel.
• Willingness to participate in holiday and on-call rotations.

Responsibilities

• Conduct coverage reviews based on member benefits and policies.
• Document clinical review findings and outcomes per policy.
• Engage with providers in peer-to-peer discussions.
• Interpret benefit language and policies during reviews.
• Participate in daily clinical rounds as requested.
• Communicate with network and non-network providers to determine benefits.

Skills

Oral communication

Written communication

Interpersonal skills

Facilitation skills

Education

MD or DO

Board certification (IM/Peds or Family Medicine)

Active medical license

Residency completed

Tools

MS Word

Outlook

Excel

Job description

UnitedHealth Group is seeking a Medical Director to support Enterprise Clinical Services from a remote location in the U.S. The role focuses on clinical coverage determinations, quality improvement, and cost-effective care, collaborating with network and non-network physicians.

Requirements include MD/DO with ABMS/AOA board certification, active medical license, 5+ years of clinical practice, and strong data and communication skills.