Remote Medical Director: Pediatrics & Internal Medicine

UnitedHealth Group; Houston (TX); Remote; Confidential; Full time

Job summary

UnitedHealth Group is seeking a Medical Director to provide physician support for Enterprise Clinical Services. This role focuses on clinical knowledge application in utilization management, benefit coverage determinations, and cost-effective care.

The position supports remote work from anywhere in the United States, with collaboration across network and non-network providers to ensure accurate and timely determinations.

Qualifications

• MD or DO degree with medical license.
• Board certification in Internal Medicine and Pediatrics (ABMS or AOA).
• Active unrestricted medical license; ability to obtain other state licenses.
• 5+ years of clinical practice after residency.
• Proven understanding of Evidence Based Medicine (EBM).
• Proficient PC skills: MS Word, Outlook, Excel.
• Ability to participate in rotational holiday and call coverage.

Responsibilities

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

Skills

Evidence Based Medicine

Clinical leadership

Communication skills

Education

MD or DO

Board certification ABMS/AOA

Active unrestricted medical license

Tools

MS Word

Outlook

Excel

Job description

UnitedHealth Group is seeking a Medical Director to provide physician support for Enterprise Clinical Services. This role focuses on clinical knowledge application in utilization management, benefit coverage determinations, and cost-effective care.

The position supports remote work from anywhere in the United States, with collaboration across network and non-network providers to ensure accurate and timely determinations.