Remote Medical Director, Pediatrics & Clinical Coverage

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

Benefits offered by this job

Comprehensive benefits

Equity stock purchase

401k contribution

Job summary

UnitedHealth Group's Optum is seeking a Medical Director to provide physician support for Enterprise Clinical Services, guiding clinical coverage determinations and medical policy activities.

The role emphasizes collaboration with network and non-network providers, utilization management, and cost-effective care, with a remote work option nationwide.

Requirements include MD or DO, ABMS or AOA board certification, active license, 5+ years of practice, and proficiency with MS Word/Outlook/Excel.

Qualifications

• MD or DO required.
• Board certification in Internal Medicine and Pediatrics OR Family Medicine per ABMS/AOA.
• Active unrestricted medical license; ability to obtain additional state licenses as needed.

Responsibilities

• Conduct coverage reviews based on member plan benefits and policies; render coverage determinations.
• Document clinical review findings, actions and outcomes per policies and regulatory requirements.
• Engage with requesting providers in peer-to-peer discussions as needed.
• Interpret benefit language and policies during clinical coverage reviews.
• Participate in daily clinical rounds as requested.
• Communicate with network and non-network providers to ensure timely benefit determinations; educate providers on plans and medical policy.
• Collaborate with internal partners and participate in holiday and call coverage rotations.

Skills

Evidence Based Medicine

MS Word

Outlook

Excel

Education

MD or DO

ABMS or AOA board certification (Internal Medicine and Pediatrics OR Family Medicine)

Active medical license

Tools

MS Word

Outlook

Excel

Job description

UnitedHealth Group's Optum is seeking a Medical Director to provide physician support for Enterprise Clinical Services, guiding clinical coverage determinations and medical policy activities.

The role emphasizes collaboration with network and non-network providers, utilization management, and cost-effective care, with a remote work option nationwide.

Requirements include MD or DO, ABMS or AOA board certification, active license, 5+ years of practice, and proficiency with MS Word/Outlook/Excel.