Remote Medical Director, Surgical Utilization & Policy

Optum; United States; A distancia; USD 249.000 - 373.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Benefits package

Incentive programs

Equity stock purchase

401k contribution

Descripción de la vacante

Optum in the United States is hiring a Medical Director to support Enterprise Clinical Services. The role focuses on pre-service benefit determinations, cost-effective care, and clinical operations with network and non-network physicians. Remote work is available nationwide.

You will lead clinical reviews, collaborate with medical staff, and ensure quality, compliant coverage decisions while supporting cost efficiency and patient outcomes across plans.

Formación

• MD or DO with board certification in any surgical specialty.
• Active unrestricted medical license and ability to obtain state licenses.
• 5+ years clinical practice after residency.
• Proven sound understanding of Evidence Based Medicine (EBM).
• Proven solid PC skills, specifically MS Word, Outlook, and Excel.
• Ability to participate in rotational holiday and call coverage.

Responsabilidades

• Conduct coverage reviews based on member plan benefits and policies, render coverage determinations.
• Document clinical review findings, actions, and outcomes per policies and regulatory requirements.
• Engage with requesting providers as needed in peer-to-peer discussions.
• Interpret existing benefit language and policies during clinical coverage reviews.
• Participate in daily clinical rounds as requested.
• Collaborate with network and non-network providers to ensure timely benefit determinations and educate about plans and policy.
• Participate in holiday and call coverage rotation.

Conocimientos

Clinical leadership

Collaborative teamwork

Data interpretation

Communication

Problem-solving

Educación

MD or DO

Herramientas

MS Word

MS Outlook

MS Excel

Descripción del empleo

Optum in the United States is hiring a Medical Director to support Enterprise Clinical Services. The role focuses on pre-service benefit determinations, cost-effective care, and clinical operations with network and non-network physicians. Remote work is available nationwide.

You will lead clinical reviews, collaborate with medical staff, and ensure quality, compliant coverage decisions while supporting cost efficiency and patient outcomes across plans.