Remote Medical Director, Utilization & Coverage

Tnafp; Boston, Northern (MA, KY); Hybrid; USD 249,000 - 373,000; Full time

Benefits offered by this job

Remote work from anywhere in the U.S.

Comprehensive benefits package

Equity stock purchase plan

401k contribution

Job summary

UnitedHealth Group is seeking a Medical Director to provide physician support for Enterprise Clinical Services, focusing on clinical coverage determinations and cost-effective care. You will collaborate with leadership to maintain medical policies and ensure quality outcomes for members.

You’ll work with a multidisciplinary team, support pre-service determinations, and participate in holiday/call coverage while promoting evidence-based medicine across the network.

Qualifications

• MD or DO required and board certified by ABMS or AOA.
• Active unrestricted medical license required.
• 5+ years of clinical practice after residency.

Responsibilities

• Conduct coverage reviews based on member plans and policies, render determinations.
• Document findings and outcomes per policies and regulatory standards.
• Engage with requesting providers for peer-to-peer discussions.

Skills

Clinical practice

Evidence Based Medicine

Communication

Rotation coverage

Education

MD or DO

Board certification (ABMS or AOA)

Tools

MS Word

Outlook

Excel

Job description

UnitedHealth Group is seeking a Medical Director to provide physician support for Enterprise Clinical Services, focusing on clinical coverage determinations and cost-effective care. You will collaborate with leadership to maintain medical policies and ensure quality outcomes for members.

You’ll work with a multidisciplinary team, support pre-service determinations, and participate in holiday/call coverage while promoting evidence-based medicine across the network.