Remote Medical Director, Utilization & Coverage

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

Benefits offered by this job

Remote work within US

Competitive benefits package

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 leadership to maintain clinical and operational processes for cost-effective, high-quality care for members.

You’ll contribute to multidisciplinary teams, communicate with providers, and participate in holiday and call coverage. The role supports remote work from anywhere in the U.S.

Qualifications

• MD or DO with board certification in a medical specialty (ABMS or AOA).
• Active unrestricted license to practice medicine and 5+ years of clinical practice post-residency.
• Strong understanding of Evidence Based Medicine and ability to use clinical data in reviews.

Responsibilities

• Perform coverage reviews and render determinations based on plan benefits and policies.
• Document findings and outcomes in accordance with policies, laws and accreditation.
• Engage with requesting providers in peer-to-peer discussions and educate on benefits and medical policy.
• Participate in clinical rounds and coordinate with network and non-network providers.

Skills

Evidence Based Medicine

Education

MD or DO

Tools

MS Word

Outlook

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 leadership to maintain clinical and operational processes for cost-effective, high-quality care for members.

You’ll contribute to multidisciplinary teams, communicate with providers, and participate in holiday and call coverage. The role supports remote work from anywhere in the U.S.