Remote Medical Director, Utilization & Coverage

Texas Health Institute; Phoenix, Northern (AZ, KY); Hybrid; USD 249,000 - 373,000; Full time

Benefits offered by this job

Comprehensive benefits package

Equity stock purchase program

401(k) contribution

Job summary

UnitedHealth Group is seeking a Medical Director to provide physician support for Enterprise Clinical Services, focusing on pre-service benefit determinations and medical necessity reviews. The role collaborates with network and non-network physicians to ensure cost-effective, high-quality care across all lines of business.

The position is remote in the United States, with responsibilities including clinical rounds, documentation, and peer-to-peer discussions.

Qualifications

• MD or DO medical degree with active unrestricted license.
• Board certification in Physical Medicine & Rehabilitation, Internal Medicine, Emergency or Family Medicine.
• 3+ years of clinical practice after residency.
• Strong understanding of Evidence Based Medicine (EBM).
• Proficient with MS Word, Outlook and Excel.

Responsibilities

• Provide physician support for enterprise clinical services and participate in clinical coverage determinations.
• Document findings, actions, and outcomes per policies and regulatory requirements.
• Engage with requesting providers in peer-to-peer discussions as needed.
• Interpret benefit language and policies during clinical coverage reviews.
• Participate in daily clinical rounds and collaborate with providers to ensure timely determinations.
• Coordinate with network and non-network physicians and internal partners to inform coverage decisions.
• Manage call coverage rotation and maintain open channels of communication.

Skills

Evidence Based Medicine

Computer skills

Clinical communication

Interpersonal skills

Education

MD or DO

Job description

UnitedHealth Group is seeking a Medical Director to provide physician support for Enterprise Clinical Services, focusing on pre-service benefit determinations and medical necessity reviews. The role collaborates with network and non-network physicians to ensure cost-effective, high-quality care across all lines of business.

The position is remote in the United States, with responsibilities including clinical rounds, documentation, and peer-to-peer discussions.