Remote Medical Director, Pediatrics & Internal Medicine

Optum; Houston (TX); On-site; USD 248,500 - 373,000; Full time

Job summary

Optum is seeking a Medical Director to provide physician leadership within Enterprise Clinical Services. You will oversee clinical coverage reviews, guide medical policy, and collaborate with network and non-network providers to ensure high-quality, cost-effective care.

This remote role requires MD/DO and board certification, licensure, and at least 5 years of practice. You will participate in holiday and call coverage, lead clinical rounds, and drive evidence-based decisions in benefit

Qualifications

• MD or DO with valid medical license.
• Board certification in Internal Medicine and Pediatrics or Family Medicine by ABMS/AOA.
• Active unrestricted medical license and ability to obtain additional state licenses.
• 5+ years of clinical practice after residency.
• Proficiency in Evidence Based Medicine (EBM).
• Strong PC skills: MS Word, Outlook, Excel.

Responsibilities

• Conduct coverage reviews based on member plan benefits and policy guidelines.
• Document clinical review findings, actions and outcomes per policies and regulations.
• Engage with requesting providers in peer-to-peer discussions.
• Interpret benefit language in clinical coverage reviews.
• Participate in daily clinical rounds as requested.
• Collaborate with network and non-network providers to ensure timely benefit determinations.
• Coordinate with internal partners and participate in holiday/call coverage.

Skills

Evidence Based Medicine

Clinical decision making

Provider communication

Education

MD or DO

ABMS/AOA board certification

Tools

MS Word

Outlook

Excel

Job description

Optum is seeking a Medical Director to provide physician leadership within Enterprise Clinical Services. You will oversee clinical coverage reviews, guide medical policy, and collaborate with network and non-network providers to ensure high-quality, cost-effective care.

This remote role requires MD/DO and board certification, licensure, and at least 5 years of practice. You will participate in holiday and call coverage, lead clinical rounds, and drive evidence-based decisions in benefit