Remote Medical Director - Pediatrics & Utilization Review

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

Benefits offered by this job

Remote work flexibility

Job summary

Optum, a global health services leader, seeks a Medical Director to support Enterprise Clinical Services. You will guide clinical coverage determinations, ensure quality and cost-effective care, and collaborate with leaders to optimize processes.

This remote role offers flexibility to work from anywhere in the United States, with responsibilities including coverage reviews, documentation, peer discussions with providers, and cross-team collaboration to ensure timely, accurate determinations for

Qualifications

• MD or DO degree with board certification in relevant specialties.
• Active, unrestricted medical license and ability to obtain state licenses as needed.
• 5+ years of clinical practice after residency; strong knowledge of EBM.

Responsibilities

• Conduct coverage reviews based on member plan benefits and policies.
• Document clinical review findings, actions, and outcomes per policies.
• Engage with requesting providers in peer-to-peer discussions as needed.
• Interpret benefit language during clinical coverage reviews.
• Participate in daily clinical rounds as requested.
• Communicate with network and non-network providers to support accurate determinations.
• Collaborate with internal partners across Enterprise Clinical Services.
• Participate in holiday and call coverage rotation.

Skills

EBM understanding

Interpersonal communication

Clinical practice

Education

MD or DO

ABMS/AOA board cert

Unrestricted medical license

Tools

MS Word

Outlook

Excel

Job description

Optum, a global health services leader, seeks a Medical Director to support Enterprise Clinical Services. You will guide clinical coverage determinations, ensure quality and cost-effective care, and collaborate with leaders to optimize processes.

This remote role offers flexibility to work from anywhere in the United States, with responsibilities including coverage reviews, documentation, peer discussions with providers, and cross-team collaboration to ensure timely, accurate determinations for