Remote Medical Director: Utilization & Coverage Strategy

Stryker Corporation; Minneapolis, Northern (MN, KY); Hybrid; Confidential; Full time

Job summary

UnitedHealth Group is seeking a Medical Director to provide physician support within Enterprise Clinical Services, focusing on clinical coverage determinations and cost-effective care delivery. You will collaborate with leadership and staff to implement processes around benefit coverage, quality improvement, and medical policy interpretation.

Remote work is supported nationwide; you will engage with network and non-network physicians, participate in clinical rounds, and drive evidence-based

Qualifications

• MD or DO degree with board certification in Sleep Medicine.
• Unrestricted medical license to practice medicine.
• 5+ years of clinical practice experience after residency.
• Proven understanding of Evidence Based Medicine (EBM).
• Proficient with MS Word, Outlook and Excel.

Responsibilities

• Conduct coverage reviews based on member plan benefits and policies, render determinations.
• 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.
• Participate in daily clinical rounds as requested.
• Collaborate with network and non-network providers for timely determinations and education.
• Collaborate with internal partners.
• Participate in occasional holiday and call coverage rotation.

Skills

EBM knowledge

Communication skills

MS Word/Outlook/Excel

Education

MD or DO

Tools

MS Word

Outlook

Excel

Job description

UnitedHealth Group is seeking a Medical Director to provide physician support within Enterprise Clinical Services, focusing on clinical coverage determinations and cost-effective care delivery. You will collaborate with leadership and staff to implement processes around benefit coverage, quality improvement, and medical policy interpretation.

Remote work is supported nationwide; you will engage with network and non-network physicians, participate in clinical rounds, and drive evidence-based