Remote Medical Director, Utilization Review & DME

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

Benefits offered by this job

Benefits package

Equity stock purchase

401k contribution

Job summary

UnitedHealth Group seeks a Medical Director to support Enterprise Clinical Services, focusing on clinical coverage determinations and cost-effective care. You will collaborate with network and non-network physicians, document reviews, and participate in clinical rounds.

The role requires MD/DO, unrestricted license, board certification, and 3+ years of clinical experience with strong communication and data-analytic skills.

Qualifications

• MD or DO and unrestricted medical license.
• Board certification in Physical Medicine & Rehabilitation, Internal Medicine, Emergency or Family Medicine.
• 3+ years of clinical practice after residency.

Responsibilities

• Conduct coverage reviews and render determinations based on plan benefits and policies.
• Document findings, actions, and outcomes per regulatory requirements.
• Engage with requesting providers in peer-to-peer discussions.
• Interpret benefit language and policies during reviews.
• Participate in daily clinical rounds and collaborate with providers.
• Communicate with network and non-network providers to ensure timely determinations.

Skills

Evidence-based medicine

Communication skills

Data analysis

MS Word

Excel

Education

MD/DO

Job description

UnitedHealth Group seeks a Medical Director to support Enterprise Clinical Services, focusing on clinical coverage determinations and cost-effective care. You will collaborate with network and non-network physicians, document reviews, and participate in clinical rounds.

The role requires MD/DO, unrestricted license, board certification, and 3+ years of clinical experience with strong communication and data-analytic skills.