Remote Medical Director, Utilization & Coverage

Tnafp; Los Angeles, Northern (CA, KY); Hybrid; USD 249,000 - 373,000; Full time

Job summary

UnitedHealth Group, through Optum, seeks a Medical Director to provide physician support for Enterprise Clinical Services. The role focuses on clinical utilization management, pre-service benefit determinations, and collaboration with network and non-network physicians.

The position offers remote work from anywhere in the U.S., with emphasis on cost-effective, high-quality care and ongoing development within a multidisciplinary team.

Qualifications

• MD or DO with active license to practice medicine.
• Board certification in ABMS internal medicine or family medicine preferred.
• 3+ years of clinical practice after residency.

Responsibilities

• Conduct coverage reviews based on member plan benefits and policies.
• Document clinical review findings and outcomes per policies and regulations.
• Engage with requesting providers in peer-to-peer discussions as needed.
• Interpret benefit language and policies in clinical coverage reviews.
• Communicate with network and non-network providers to ensure timely determinations.

Skills

Clinical practice

EBM

Communication

Education

MD or DO

Active medical license

Board certification in ABMS Internal/Family Medicine preferred

Tools

MS Word

Outlook

Excel

Job description

UnitedHealth Group, through Optum, seeks a Medical Director to provide physician support for Enterprise Clinical Services. The role focuses on clinical utilization management, pre-service benefit determinations, and collaboration with network and non-network physicians.

The position offers remote work from anywhere in the U.S., with emphasis on cost-effective, high-quality care and ongoing development within a multidisciplinary team.