Remote Medical Director: Utilization & Coverage

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

Job summary

UnitedHealth Group is hiring a Medical Director to provide physician support for Enterprise Clinical Services. You will lead clinical coverage determinations, document reviews, and collaborate with network and non-network physicians to optimize medical necessity decisions.

The role emphasizes utilization management, evidence-based medicine and cross-functional teamwork. Remote work within the United States is supported with comprehensive benefits.

Qualifications

• MD/DO required and licensed to practice
• Board certification in ABMS specialty; Internal Medicine or Family Medicine preferred
• 3+ years of clinical practice after residency
• Demonstrated understanding of Evidence Based Medicine (EBM)
• Strong PC skills: Word, Outlook, Excel

Responsibilities

• Conduct clinical coverage reviews based on member benefits and review policies
• Document findings and outcomes per regulatory and policy requirements
• Engage with requesting providers in peer-to-peer discussions
• Interpret benefit language and policies for coverage decisions
• Communicate with network and non-network providers to educate on benefits
• Collaborate with internal partners to ensure accurate determinations
• Participate in coverage rotation and ongoing quality improvements

Skills

M.D. or D.O.

EBM

MS Word

Outlook

Excel

Clinical practice

Education

MD/DO degree

ABMS board certification (Internal/Family preferred)

Tools

MS Word

Outlook

Excel

Job description

UnitedHealth Group is hiring a Medical Director to provide physician support for Enterprise Clinical Services. You will lead clinical coverage determinations, document reviews, and collaborate with network and non-network physicians to optimize medical necessity decisions.

The role emphasizes utilization management, evidence-based medicine and cross-functional teamwork. Remote work within the United States is supported with comprehensive benefits.