Remote Medical Director: Utilization Management & Coverage

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

Job summary

UnitedHealth Group in Minnesota seeks a Medical Director to provide physician support for Enterprise Clinical Services and oversee clinical coverage determinations and medical necessity reviews.

The role partners with a multidisciplinary team to ensure cost-effective, high-quality care, advances utilization management, and communicates policies to network and non-network physicians. Remote work from anywhere in the U.S. is supported.

Qualifications

• MD or DO degree and board certification in a medical specialty.
• Active unrestricted medical license.
• 5+ years of clinical practice after residency.
• Proficiency with basic MS Office tools (Word, Outlook, Excel).

Responsibilities

• Conduct coverage reviews based on member plan benefits and policies.
• Document review findings and outcomes per regulatory requirements.
• Engage with requesting providers in peer-to-peer discussions.
• Interpret benefit language and policies during clinical reviews.
• Participate in daily clinical rounds as requested.
• Collaborate with network and non-network providers to determine timely benefit decisions.

Skills

Evidence Based Medicine

MS Word/Outlook/Excel

Education

MD or DO

ABMS/AOA board certification

Unrestricted medical license

5+ years clinical practice

Job description

UnitedHealth Group in Minnesota seeks a Medical Director to provide physician support for Enterprise Clinical Services and oversee clinical coverage determinations and medical necessity reviews.

The role partners with a multidisciplinary team to ensure cost-effective, high-quality care, advances utilization management, and communicates policies to network and non-network physicians. Remote work from anywhere in the U.S. is supported.