Remote Medical Director, Utilization & Clinical Coverage

Ascension St Vincent; Houston (TX); Remote; USD 249,000 - 373,000; Full time

Job summary

UnitedHealth Group seeks a Medical Director to provide physician support for Enterprise Clinical Services, focusing on pre-service benefit determinations, medical necessity, and cost-effective care.

The role involves collaborating with multidisciplinary teams, communicating with network and non-network physicians, and participating in holiday and call coverage rotations. Remote work within the U.S. is allowed.

Qualifications

• MD or DO with board certification in IM/ Pediatrics or Family Medicine.
• Active unrestricted medical license; ability to obtain licenses as needed.
• 5+ years of clinical practice after residency; strong EBM knowledge.

Responsibilities

• Conduct coverage reviews and render determinations based on plan benefits and policies.
• Document clinical review findings in accordance with policies and regulatory requirements.
• Engage with requesting providers in peer-to-peer discussions as needed.
• Collaborate with network and non-network physicians to ensure timely determinations.

Skills

Clinical judgment

Communication

MS Office proficiency

Analytical thinking

Presentation skills

Education

MD or DO

Board certification (IM/ pediatrics or Family Medicine)

Active medical license

Tools

MS Word

Outlook

Excel

Job description

UnitedHealth Group seeks a Medical Director to provide physician support for Enterprise Clinical Services, focusing on pre-service benefit determinations, medical necessity, and cost-effective care.

The role involves collaborating with multidisciplinary teams, communicating with network and non-network physicians, and participating in holiday and call coverage rotations. Remote work within the U.S. is allowed.