Remote PM&R Medical Director — Clinical Utilization & Coverage

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

Job summary

Optum, a national health services company, seeks a Medical Director to support Enterprise Clinical Services. The role emphasizes clinical coverage determinations, cost-effective care, and collaboration with network and non-network physicians while maintaining licensure and board certification.

This remote position allows work from anywhere in the United States. The candidate must hold an MD or DO, be board-certified in PM&R or Internal Medicine, and have 5+ years of clinical practice.

Qualifications

• MD or DO board-certified in PM&R or Internal Medicine.
• Active unrestricted medical license to practice medicine.
• 5+ years of clinical practice experience after residency.
• Solid understanding of Evidence Based Medicine (EBM).
• Proficient MS Word, Outlook and Excel skills.
• Willingness to participate in holiday and call coverage rotation.

Responsibilities

• Conduct coverage reviews based on member plan benefits and policies.
• Render coverage determinations and document findings and outcomes.
• Engage with requesting providers in peer-to-peer discussions as needed.
• Interpret benefit language and policies during clinical reviews.
• Participate in daily clinical rounds when requested.
• Collaborate with network and non-network providers for timely determinations.
• Coordinate with internal partners to support benefit plans and policies.
• Participate in holiday and call coverage rotation.

Skills

Evidence Based Medicine

Communication skills

Education

MD or DO

Board certification in Physical Medicine & Rehabilitation or Internal Medicine

Active unrestricted medical license

Tools

MS Word

Outlook

Excel

Job description

Optum, a national health services company, seeks a Medical Director to support Enterprise Clinical Services. The role emphasizes clinical coverage determinations, cost-effective care, and collaboration with network and non-network physicians while maintaining licensure and board certification.

This remote position allows work from anywhere in the United States. The candidate must hold an MD or DO, be board-certified in PM&R or Internal Medicine, and have 5+ years of clinical practice.