Remote Medical Director - Utilization & Clinical Strategy

ISHE; Los Angeles, Northern (CA, KY); Hybrid; USD 249,000 - 373,000; Full time

Benefits offered by this job

Benefits package

Equity options

401(k) contribution

Job summary

UnitedHealth Group is seeking a Medical Director to provide physician support for Enterprise Clinical Services, overseeing clinical coverage determinations and utilization management. The role emphasizes evidence-based reviews, collaboration with network and non-network physicians, and cross-functional coordination to ensure cost-effective care.

The position offers remote work nationwide within the U.S. and requires medical licensure, board certification, and several years of clinical practice.

Qualifications

• MD/DO with an active license to practice medicine.
• Board certification in an ABMS specialty; internal medicine or family medicine preferred.
• 3+ years of clinical practice after residency.
• Strong understanding of Evidence Based Medicine (EBM).
• Proficiency with MS Word, Outlook and Excel.

Responsibilities

• Conduct coverage reviews based on member plan benefits and review policies.
• Document clinical review findings, actions, and outcomes per policies and regulatory requirements.
• Engage with requesting providers in peer-to-peer discussions as needed.
• Interpret benefit language and policies in clinical coverage reviews.
• Communicate with network and non-network providers to ensure accurate benefit determinations.
• Coordinate with internal partners and participate in coverage rotation.

Skills

MD/DO

Active medical license

Board certification

Clinical experience

Evidence Based Medicine

MS Word/Outlook/Excel

Job description

UnitedHealth Group is seeking a Medical Director to provide physician support for Enterprise Clinical Services, overseeing clinical coverage determinations and utilization management. The role emphasizes evidence-based reviews, collaboration with network and non-network physicians, and cross-functional coordination to ensure cost-effective care.

The position offers remote work nationwide within the U.S. and requires medical licensure, board certification, and several years of clinical practice.