Remote Medical Director, Utilization Management

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

Benefits offered by this job

Comprehensive benefits package

Equity stock purchase

401k contribution

Incentive programs

Job summary

UnitedHealth Group's Enterprise Clinical Services seeks a Medical Director to provide physician support and lead clinical coverage reviews for members. You will collaborate with a multidisciplinary team to ensure cost-effective, high-quality care across national plans.

The role requires MD/DO, board certification, and 5+ years of clinical practice, with strong EBM knowledge and MS Office proficiency. This is a remote, full-time position with comprehensive benefits.

Qualifications

• MD or DO with board certification and active license.
• Solid understanding of Evidence Based Medicine (EBM).
• 5+ years of clinical practice after residency.

Responsibilities

• Conduct coverage reviews and render determinations based on plan benefits and policies.
• Document findings and outcomes in accordance with policies and regulations.
• Engage with requesting providers in peer-to-peer discussions.
• Interpret benefit language and policies during clinical reviews.
• Participate in daily clinical rounds and collaborate with providers.

Skills

MS Word

Outlook

Excel

Evidence Based Medicine

Education

MD or DO

Board certification ABMS or AOA

Job description

UnitedHealth Group's Enterprise Clinical Services seeks a Medical Director to provide physician support and lead clinical coverage reviews for members. You will collaborate with a multidisciplinary team to ensure cost-effective, high-quality care across national plans.

The role requires MD/DO, board certification, and 5+ years of clinical practice, with strong EBM knowledge and MS Office proficiency. This is a remote, full-time position with comprehensive benefits.