Remote Medical Director, Utilization & Coverage

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

Job summary

Optum is hiring a Medical Director to provide physician support for Enterprise Clinical Services and lead clinical coverage determinations. You will collaborate with leadership to maintain efficient clinical and operational processes and ensure cost-effective, high-quality care for members.

The role emphasizes pre-service determinations, communication with physicians, and participation in clinical rounds. Remote work is available from anywhere in the U.S. with competitive compensation.

Qualifications

• MD or DO degree required and board-certified in a medical specialty.
• Active unrestricted license to practice medicine.
• 5+ years of clinical practice after residency.

Responsibilities

• Conduct coverage reviews based on member plan benefits and policies.
• Document clinical review findings and outcomes per policy and regulatory requirements.
• Engage with requesting providers in peer-to-peer discussions.
• Interpret benefit language and policies in clinical reviews.
• Participate in daily clinical rounds and collaborate with network and non-network providers.

Skills

MD or DO degree

ABMS/AOA board certification

Active medical license

Clinical practice 5+ years

Evidence Based Medicine

MS Word

Outlook

Excel

Education

MD or DO

Tools

MS Word

Outlook

Excel

Job description

Optum is hiring a Medical Director to provide physician support for Enterprise Clinical Services and lead clinical coverage determinations. You will collaborate with leadership to maintain efficient clinical and operational processes and ensure cost-effective, high-quality care for members.

The role emphasizes pre-service determinations, communication with physicians, and participation in clinical rounds. Remote work is available from anywhere in the U.S. with competitive compensation.