Remote Medical Director - Utilization & DME Review

RXinsider LTD.; Phoenix, Northern (AZ, KY); Hybrid; USD 249,000 - 373,000; Full time

Benefits offered by this job

Comprehensive benefits package

Remote work from anywhere within the U

Job summary

UnitedHealth Group seeks a Medical Director to provide physician support for Enterprise Clinical Services. You will apply clinical knowledge to benefit coverage determinations and quality improvements while collaborating with providers and internal teams.

The role offers remote work from anywhere in the U.S., with emphasis on cost-effective, high-quality care and strong communication across stakeholders.

Qualifications

• MD or DO 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

• Conduct coverage reviews based on member plan benefits and review policies.
• Render coverage determinations and document findings per policy.
• Engage with requesting providers in peer-to-peer discussions as needed.
• Interpret benefit language and policies during clinical reviews.
• Participate in daily clinical rounds as requested.
• Collaborate with network and non-network providers for timely determinations.

Skills

Communication skills

Interpersonal skills

Problem solving

Team collaboration

Education

MD or DO

Tools

MS Word

Outlook

Excel

Job description

UnitedHealth Group seeks a Medical Director to provide physician support for Enterprise Clinical Services. You will apply clinical knowledge to benefit coverage determinations and quality improvements while collaborating with providers and internal teams.

The role offers remote work from anywhere in the U.S., with emphasis on cost-effective, high-quality care and strong communication across stakeholders.