Remote Senior Medical Director, AI & Utilization Management

Tnafp; Minnetonka, Northern (MN, KY); Hybrid; USD 387,000 - 580,000; Full time

Benefits offered by this job

Benefits package

Equity stock purchase

401k contribution

Remote work flexibility

Job summary

UnitedHealthcare is seeking a Medical Director, Clinical AI Innovation and Performance to lead clinical annotation, model training and governance for AI-enabled Utilization Management. You will establish interpretation standards for InterQual criteria and ensure evidence-based UM criteria are accurately translated into operational decision support.

Remote work is supported from anywhere in the U.S. with a focus on Prior Authorization and expansion to inpatient level of care.

Qualifications

• MD or DO with active/unrestricted U.S. medical license.
• Board certification in an ABMS/AOBMS clinical specialty.
• Significant utilization management experience at scale.

Responsibilities

• Lead clinical annotation and model training for UM decision support.
• Interpret and enhance InterQual criteria for consistent care decisions.
• Collaborate with Medical Policy, CARES, and AI teams to advance policy alignment.
• Own governance of AI life cycle from training to production deployment.
• Ensure safe, effective, evidence-based coverage decisions across enterprise.

Skills

InterQual expertise

Evidence-based UM

Leadership across teams

AI governance

Clinical judgment

Education

MD or DO with US licensure

Board certification in clinical specialty

Tools

InterQual

MCG guidelines

LLM training for UM

Job description

UnitedHealthcare is seeking a Medical Director, Clinical AI Innovation and Performance to lead clinical annotation, model training and governance for AI-enabled Utilization Management. You will establish interpretation standards for InterQual criteria and ensure evidence-based UM criteria are accurately translated into operational decision support.

Remote work is supported from anywhere in the U.S. with a focus on Prior Authorization and expansion to inpatient level of care.