Remote Medical Director: Utilization & Benefits Strategy

Optum; Boston (MA); Remote; USD 249,000 - 373,000; Full time

Benefits offered by this job

Remote work within the U.S.

Job summary

Optum is seeking a Medical Director to provide physician support for Enterprise Clinical Services, focusing on pre-service benefit determinations and medical necessity decisions. You will collaborate with network and non-network physicians to ensure appropriate, cost-effective care.

You will lead clinical reviews, educate providers on benefits and medical policy, and participate in multidisciplinary rounds from a remote location within the U.S.

Qualifications

• MD or DO required.
• Board certification in General Surgery with vascular surgery experience.
• Active unrestricted medical license required.
• 5+ years of clinical practice after residency.

Responsibilities

• Conduct coverage reviews based on member plan benefits and policies; render coverage determinations.
• Document clinical review findings, actions and outcomes per policies and accreditation requirements.
• Engage with requesting providers in peer-to-peer discussions as needed.
• Interpret benefit language and policies for clinical coverage reviews.
• Participate in daily clinical rounds as requested.
• Collaborate with network and non-network providers to ensure accurate and timely determinations.
• Handle call coverage rotation.

Skills

Clinical practice

EBM understanding

Communication skills

MS Word

Outlook

Excel

Education

MD or DO

ABMS or AOA board cert with vascular surgery

Active unrestricted medical license

5+ years clinical practice after residency

Tools

Microsoft Word

Microsoft Outlook

Microsoft Excel

Job description

Optum is seeking a Medical Director to provide physician support for Enterprise Clinical Services, focusing on pre-service benefit determinations and medical necessity decisions. You will collaborate with network and non-network physicians to ensure appropriate, cost-effective care.

You will lead clinical reviews, educate providers on benefits and medical policy, and participate in multidisciplinary rounds from a remote location within the U.S.