Remote Medical Director: Surgical Coverage & Advocacy

Optum; United States; Remote; USD 249,000 - 373,000; Full time

Job summary

Optum is seeking a Medical Director to provide physician leadership within Enterprise Clinical Services, focusing on pre-service benefit determinations and medical necessity. This remote role supports UnitedHealth Group's mission to improve health outcomes by using evidence-based medicine and cost-effective care.

You will review coverage, document findings, engage with providers, and collaborate with network and non-network teams.

Qualifications

• MD or DO with active unrestricted license.
• Active board certification from the ABMS or AOA.
• 3+ years of clinical practice after residency.
• Demonstrated understanding of Evidence Based Medicine (EBM).
• Proficient in MS Word, Outlook and Excel.

Responsibilities

• Conduct coverage reviews based on member plan benefits and review policies.
• Document clinical review findings, actions, and outcomes.
• Engage with requesting providers in peer-to-peer discussions.
• Interpret existing benefit language and policies during reviews.
• Communicate with network and non-network providers to ensure accurate determinations.
• Participate in coverage rotation.

Skills

Evidence Based Medicine

Communication skills

Clinical leadership

Education

MD or DO

Tools

MS Word

Outlook

Excel

Job description

Optum is seeking a Medical Director to provide physician leadership within Enterprise Clinical Services, focusing on pre-service benefit determinations and medical necessity. This remote role supports UnitedHealth Group's mission to improve health outcomes by using evidence-based medicine and cost-effective care.

You will review coverage, document findings, engage with providers, and collaborate with network and non-network teams.