Remote Medical Director, Pediatrics & Utilization

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

Job summary

Optum is seeking a Medical Director to provide physician support for Enterprise Clinical Services operations, focusing on clinical coverage determinations, cost-effective care and medical policy communication with network and non-network physicians. The role offers remote work from anywhere in the U.S.

and requires MD/DO with ABMS/AOA board certification in Internal Medicine and Pediatrics or Family Medicine, plus 5+ years of clinical practice and licensure.

Qualifications

• MD or DO required.
• Board certification in Internal Medicine and Pediatrics OR Family Medicine (ABMS/AOA).
• Active unrestricted medical license; ability to obtain additional state licenses.
• 5+ years of clinical practice after residency.

Responsibilities

• Conduct clinical coverage reviews to determine medical necessity and benefits.
• Document findings and outcomes per policies and regulatory requirements.
• Engage with requesting providers in peer-to-peer discussions as needed.
• Collaborate with network and non-network physicians to ensure accurate determinations and policy understanding.
• Participate in holiday and call coverage rotations.

Education

MD/DO

ABMS/AOA board certified

Active medical license

Clinical practice 5+ years

Tools

MS Word

Outlook

Excel

Job description

Optum is seeking a Medical Director to provide physician support for Enterprise Clinical Services operations, focusing on clinical coverage determinations, cost-effective care and medical policy communication with network and non-network physicians. The role offers remote work from anywhere in the U.S.

and requires MD/DO with ABMS/AOA board certification in Internal Medicine and Pediatrics or Family Medicine, plus 5+ years of clinical practice and licensure.