Remote PM&R Medical Director - Coverage & Utilization

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

Job summary

UnitedHealth Group is seeking a Medical Director to provide physician support for Enterprise Clinical Services, leading clinical coverage reviews and medical necessity determinations while collaborating with network and non-network physicians to ensure cost-effective, high-quality care.

This remote role involves documenting findings, engaging in peer-to-peer discussions, and participating in clinical rounds.

Qualifications

• MD or DO degree and board certification in PM&R or Internal Medicine.
• Unrestricted license to practice medicine in any state.
• 5+ years of clinical practice after residency.
• Strong understanding of Evidence Based Medicine (EBM).
• Proficiency with MS Word, Outlook, and Excel.

Responsibilities

• Conduct coverage reviews and render determinations based on plan benefits and policies.
• Document clinical review findings and outcomes per regulatory requirements.
• Engage in peer-to-peer discussions with requesting providers as needed.
• Interpret benefit language and policies in clinical coverage reviews.
• Participate in daily clinical rounds when requested.
• Collaborate with network and non-network providers to ensure accurate determinations and educate providers.
• Collaborate with internal partners to achieve seamless processes.
• Participate in holiday and call coverage rotation as required.

Skills

Evidence Based Medicine

Communication skills

Data analysis

Presentation skills

Problem solving

Interpersonal communication

Education

MD or DO

Board certification in Physical Medicine & Rehabilitation or Internal Medicine

Active unrestricted medical license

Tools

MS Word

Outlook

Excel

Job description

UnitedHealth Group is seeking a Medical Director to provide physician support for Enterprise Clinical Services, leading clinical coverage reviews and medical necessity determinations while collaborating with network and non-network physicians to ensure cost-effective, high-quality care.

This remote role involves documenting findings, engaging in peer-to-peer discussions, and participating in clinical rounds.