Remote Medical Director: Pediatrics & Internal Medicine

UnitedHealth Group; Phoenix (AZ); Remote; Confidential; Full time

Job summary

UnitedHealth Group is seeking a Medical Director to provide physician support to Enterprise Clinical Services, leading clinical coverage determinations and medical necessity reviews. This remote role serves members nationwide, collaborating with network and non-network physicians to ensure cost-effective, high-quality care.

The position requires MD/DO, ABMS or AOA board certification in Internal Medicine/ Pediatrics or Family Medicine, an active license, and 5+ years of clinical practice with

Qualifications

• MD or DO required.
• Board certification in Internal Medicine and Pediatrics OR Family Medicine (ABMS or AOA).
• Active unrestricted medical license and ability to obtain additional state licenses as needed.
• 5+ years of clinical practice after residency.
• Strong understanding of Evidence Based Medicine (EBM).
• Proficient MS Word, Outlook, and Excel skills.
• Ability to participate in rotational holiday and call coverage.

Responsibilities

• Conduct coverage reviews based on member benefits and policies; render coverage determinations.
• Document clinical review findings, actions and outcomes per policies and regulations.
• 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 and collaborate with network and non-network providers to ensure timely benefit determinations.

Skills

Evidence Based Medicine

Clinical practice

Communication skills

Education

MD or DO

Tools

MS Word

Outlook

Excel

Job description

UnitedHealth Group is seeking a Medical Director to provide physician support to Enterprise Clinical Services, leading clinical coverage determinations and medical necessity reviews. This remote role serves members nationwide, collaborating with network and non-network physicians to ensure cost-effective, high-quality care.

The position requires MD/DO, ABMS or AOA board certification in Internal Medicine/ Pediatrics or Family Medicine, an active license, and 5+ years of clinical practice with