Remote PM&R Medical Director: Utilization & Coverage

ISHE

Minneapolis, Northern (MN, KY)

Hybrid

USD 249,000 - 373,000

Full time

6 days ago

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Benefits offered by this job

Benefits package

401k plan

Stock purchase

Job summary

UnitedHealth Group is seeking a Medical Director to provide physician support for Enterprise Clinical Services, overseeing clinical coverage determinations and cost-effective care. This remote role allows you to work from anywhere in the United States while collaborating with a multidisciplinary team to improve patient outcomes.

The position requires an MD or DO, board certification, active license, and 5+ years of clinical practice, with strong knowledge of Evidence Based Medicine and

Qualifications

MD or DO degree required.
Board certification in PM&R or Internal Medicine.
Active unrestricted medical license required.
Minimum 5 years of clinical practice after residency.
Strong understanding of Evidence Based Medicine.
Proficient in MS Word, Outlook, and Excel.

Responsibilities

Conduct coverage reviews based on member plan benefits and policies.
Document clinical review findings and outcomes per policy and regs.
Engage with requesting providers in peer‑to‑peer discussions.
Interpret benefit language during clinical coverage reviews.
Participate in daily clinical rounds as requested.
Collaborate with network and non-network providers on determinations.
Participate in holiday and call coverage rotations.

Skills

Medical knowledge

Evidence Based Medicine

MS Word/Outlook/Excel

Communication skills

Education

MD/DO

Tools

Electronic Health Records

Job description

The position requires an MD or DO, board certification, active license, and 5+ years of clinical practice, with strong knowledge of Evidence Based Medicine and

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