Remote Medical Director - Utilization & Coverage

Sustainable World, Inc.; Phoenix, Northern (AZ, KY); 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, focusing on clinical coverage determinations and medical necessity reviews. You will collaborate with leadership to maintain processes and assure cost-effective high-quality care.

The role involves remote work from anywhere in the United States, engagement in peer discussions, and communication with providers to educate on benefits and policy.

Qualifications

• MD or DO degree and active unrestricted license.
• Board certification in PM&R, IM, EM, or FM.
• 3+ years of clinical practice after residency.
• Strong understanding of Evidence Based Medicine (EBM).
• Proficient with MS Word, Outlook and Excel.

Responsibilities

• Conduct coverage reviews based on member benefits and policies and render determinations.
• Document review findings and outcomes per policy and regulatory requirements.
• Engage with healthcare providers in peer-to-peer discussions as needed.
• Interpret benefit language and policies in clinical coverage reviews.
• Participate in daily clinical rounds as requested.
• Collaborate with network and non-network providers to ensure timely determinations.

Skills

Clinical Expertise

Communication Skills

MS Word

Outlook

Excel

Education

MD/DO degree

Board certification in Physical Medicine & Rehabilitation or Internal/Emergency/Family Medicine

Tools

MS Word

Outlook

Excel

Job description

UnitedHealth Group is seeking a Medical Director to provide physician support for Enterprise Clinical Services, focusing on clinical coverage determinations and medical necessity reviews. You will collaborate with leadership to maintain processes and assure cost-effective high-quality care.

The role involves remote work from anywhere in the United States, engagement in peer discussions, and communication with providers to educate on benefits and policy.