Remote Medical Director, Utilization & Coverage

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

Benefits offered by this job

Remote work within US

Comprehensive benefits package

Job summary

UnitedHealth Group in the United States invites applications for a Medical Director who will provide physician support to Enterprise Clinical Services and oversee clinical coverage determinations. You will collaborate with leadership to maintain processes for benefit coverage and cost-effectiveness, guiding network and non-network physicians toward optimal care.

The role offers remote work from anywhere in the U.S., with participation in holiday and call coverage.

Qualifications

• MD or DO degree.
• ABMS board certification or AOA.
• Active unrestricted medical license.
• 5+ years of clinical practice after residency.
• Strong knowledge of Evidence Based Medicine.
• Proficient PC skills: Word, Outlook, Excel.
• Willingness to participate in holiday and call coverage.

Responsibilities

• Conduct coverage reviews based on member benefits and policies.
• Document clinical review findings in compliance with policies.
• Engage with requesting providers for peer discussions.
• Interpret benefit language and policies for clinical coverage reviews.
• Participate in daily clinical rounds as requested.
• Communicate with network and non-network providers for timely determinations.
• Collaborate with internal partners.
• Participate in holiday and call coverage rotation.

Skills

Medical license

EBM

Clinical experience

Microsoft Word

Microsoft Outlook

Microsoft Excel

Call coverage

Education

MD/DO

Job description

UnitedHealth Group in the United States invites applications for a Medical Director who will provide physician support to Enterprise Clinical Services and oversee clinical coverage determinations. You will collaborate with leadership to maintain processes for benefit coverage and cost-effectiveness, guiding network and non-network physicians toward optimal care.

The role offers remote work from anywhere in the U.S., with participation in holiday and call coverage.