Remote Medical Director, Utilization & Coverage

Careerwebsite; Houston (TX); Hybrid; USD 249,000 - 373,000; Full time

Job summary

UnitedHealth Group is seeking a Medical Director to provide physician support for Enterprise Clinical Services, overseeing clinical coverage determinations and collaboration with network and non-network providers. The role focuses on evidence-based review, cost-effective care, and quality improvement while enabling remote work across the United States.

Responsibilities include leading coverage reviews, documenting findings, and participating in clinical rounds.

Qualifications

• M.D or D.O.
• Board certification in Internal Medicine and Pediatrics OR Family Medicine through ABMS or AOA
• Active unrestricted medical license and ability to obtain additional state medical licenses as needed
• 5+ years of clinical practice experience after completing residency training
• Proven sound understanding of Evidence Based Medicine (EBM)
• Proven solid PC skills, specifically using MS Word, Outlook, and Excel
• Ability to participate in rotational holiday and call coverage

Responsibilities

• Conduct coverage reviews based on member plan benefits and policies
• Document clinical review findings, actions, and outcomes
• Engage with requesting providers in peer-to-peer discussions
• Interpret benefit language and policies in clinical reviews
• Participate in daily clinical rounds
• Communicate with network and non-network providers to ensure timely determinations
• Collaborate with internal partners and participate in holiday/call coverage

Skills

MS Word

Outlook

Excel

Clinical practice

EBM

Education

MD/DO degree

Job description

UnitedHealth Group is seeking a Medical Director to provide physician support for Enterprise Clinical Services, overseeing clinical coverage determinations and collaboration with network and non-network providers. The role focuses on evidence-based review, cost-effective care, and quality improvement while enabling remote work across the United States.

Responsibilities include leading coverage reviews, documenting findings, and participating in clinical rounds.