Remote Medical Director, Vascular Surgery

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

Benefits offered by this job

Remote work within the U.S.

Job summary

Optum, part of UnitedHealth Group, seeks a Medical Director to lead the Focus Claims Review team, overseeing medical services, provider interactions, and policy development in a remote-capable setting across the United States.

The role requires board-certified physicians with deep clinical experience and proficiency in coding reviews, regulatory standards, and telephonic collaboration with providers and staff.

Qualifications

• MD or DO with a current, active, and fully unrestricted medical license.
• Board certification through the American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA) in Vascular Surgery.
• 5+ years of clinical experience post residency.
• Proficient in MS Office (Word, Excel, PowerPoint).

Responsibilities

• Reviews surgical and other professional claims for correct coding using clinical record.
• Participation in Training regarding URAC, NCQA, Regulatory Compliance, Confidentiality, Conflict of Interest, HIPAA, and department specific training as applicable.
• Discusses cases and clinical coding situations with treating providers telephonically during scheduled hours.
• Participates in periodic clinical conferences / calls and in ongoing internal performance consistency reviews.
• Composes, if needed, patient situation-specific, clinical summaries and rationales for medical necessity decisions.
• Supports compliance with regulatory agency standards and requirements (e.g., CMS, NCQA, URAC, state / federal and third-party payers).
• Provide Clinical support for staff that conduct initial reviews.

Education

MD or DO with medical license

ABMS/AOA board certification in Vascular Surgery

Tools

MS Office

Job description

Optum, part of UnitedHealth Group, seeks a Medical Director to lead the Focus Claims Review team, overseeing medical services, provider interactions, and policy development in a remote-capable setting across the United States.

The role requires board-certified physicians with deep clinical experience and proficiency in coding reviews, regulatory standards, and telephonic collaboration with providers and staff.