Remote Medical Director, Utilization & Policy

UnitedHealth Group; Los Angeles (CA); Remote; Confidential; Full time

Benefits offered by this job

Remote work flexibility

Job summary

UnitedHealth Group is seeking a Medical Director to provide physician support for Enterprise Clinical Services, focusing on clinical coverage determinations and evidence-based decision-making. You will collaborate with network and non-network physicians and senior clinicians to optimize care and cost effectiveness.

The role allows remote work from anywhere in the United States, with responsibilities spanning coverage reviews, documentation, and peer discussions.

Qualifications

• MD/DO with active, unrestricted license.
• Board certification in an ABMS specialty (Internal Medicine or Family Medicine preferred).
• 3+ years of clinical practice after residency.
• Strong understanding of Evidence Based Medicine (EBM).
• Proficient in MS Word, Outlook and Excel.

Responsibilities

• Conduct coverage reviews based on member benefits and review policies.
• Document clinical review findings, actions, and outcomes.
• Engage with requesting providers in peer-to-peer discussions.
• Interpret benefit language and policies during reviews.
• Collaborate with network and non-network providers to determine benefits.
• Collaborate with internal partners to ensure timely determinations.
• Manage coverage rotation scheduling.

Skills

Clinical decision making

Evidence Based Medicine (EBM)

Interpersonal communication

Oral & written communication

Facilitation skills

Data analysis

Problem-solving

Presentation skills

Education

MD/DO

Board certification in ABMS specialty (Internal Medicine or Family Medicine preferred)

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 evidence-based decision-making. You will collaborate with network and non-network physicians and senior clinicians to optimize care and cost effectiveness.

The role allows remote work from anywhere in the United States, with responsibilities spanning coverage reviews, documentation, and peer discussions.