Remote Medical Director, Vascular Surgery Claims

RXinsider LTD.; Minneapolis (MN); Remote; USD 249,000 - 373,000; Full time

Benefits offered by this job

Comprehensive benefits package

Incentives & recognition programs

Equity stock purchase

401k contributions

Job summary

UnitedHealth Group seeks a Medical Director to lead the claims review program, ensuring quality and coordination of medical services. The role involves provider conversations, policy input, and oversight of clinical criteria across programs.

This position offers remote work flexibility from anywhere in the U.S. and requires physician licensure, ABMS/AOA board certification, and extensive clinical experience.

Qualifications

• MD or DO with a current, active medical license.
• Board certification through ABMS or AOA in a medical specialty (Vascular Surgery).
• 5+ years of clinical experience post residency.
• Proficient with MS Office applications.

Responsibilities

• Reviews surgical and other professional claims for correct coding using clinical records.
• Participation in URAC, NCQA, Regulatory Compliance, Confidentiality, Conflict of Interest, HIPAA trainings.
• Discusses cases and clinical coding with treating providers telephonically during scheduled hours.
• Participates in periodic clinical conferences/calls and internal performance reviews.
• Composes patient-specific clinical summaries and rationales for medical necessity decisions.
• Supports compliance with CMS, NCQA, URAC, state/federal and third-party payer standards.
• Provide clinical support for staff that conduct initial reviews.

Education

MD/DO physician credential

Tools

MS Office

Job description

UnitedHealth Group seeks a Medical Director to lead the claims review program, ensuring quality and coordination of medical services. The role involves provider conversations, policy input, and oversight of clinical criteria across programs.

This position offers remote work flexibility from anywhere in the U.S. and requires physician licensure, ABMS/AOA board certification, and extensive clinical experience.