Remote Medical Director, Vascular Surgery & Claims

UnitedHealth Group; Dallas (TX); Remote; USD 249,000 - 373,000; Full time

Job summary

UnitedHealth Group is seeking a Medical Director to lead the Focus Claims Review team. The role ensures quality and coordination of medical review services, including provider telephonic discussions and appeals.

Remote work is allowed within the U.S., with opportunities to shape policies and clinical criteria for programs. The candidate will require MD/DO licensure, ABMS/AOA vascular surgery board certification, and 5+ years of clinical experience, along with strong MS Office skills to support

Qualifications

• MD or DO with a current, active medical license.
• ABMS or AOA board certification in vascular surgery.
• 5+ years of clinical experience after residency.
• Proficient with MS Office applications.

Responsibilities

• Reviews surgical and other professional claims for correct coding using clinical records.
• Participates in training on URAC, NCQA, regulatory compliance, confidentiality, conflicts of interest, HIPAA, and related topics.
• Discusses cases and clinical coding with treating providers telephonically during scheduled hours.
• Participates in periodic clinical conferences/calls and in internal performance reviews.
• Composes patient-specific clinical summaries and rationales for medical necessity decisions.
• Supports compliance with CMS, NCQA, URAC, and other standards.
• Provides clinical support for staff that conduct initial reviews.

Skills

Clinical leadership

Communication with providers

Remote collaboration

MS Office

Education

MD or DO

ABMS/AOA board certification in Vascular Surgery

Tools

MS Office

Job description

UnitedHealth Group is seeking a Medical Director to lead the Focus Claims Review team. The role ensures quality and coordination of medical review services, including provider telephonic discussions and appeals.

Remote work is allowed within the U.S., with opportunities to shape policies and clinical criteria for programs. The candidate will require MD/DO licensure, ABMS/AOA vascular surgery board certification, and 5+ years of clinical experience, along with strong MS Office skills to support