Remote Sleep Medicine Medical Director

Texas Health Institute; Minneapolis (MN); Hybrid; USD 249,000 - 373,000; Full time

Job summary

UnitedHealth Group’s Optum division seeks a Medical Director to provide physician support for Enterprise Clinical Services, overseeing pre-service benefit determinations and clinical coverage reviews to optimize care and cost efficiency. You will collaborate with network and non-network physicians and cross-functional teams to ensure compliant, evidence-based decisions.

The role emphasizes leadership in utilization management, communication, and continuous improvement within a remote-work

Qualifications

• MD or DO with board certification in Sleep Medicine.
• Active unrestricted license to practice medicine.
• 5+ years of clinical practice experience.
• Proven understanding of Evidence Based Medicine (EBM).
• Proven PC skills: MS Word, Outlook and Excel.

Responsibilities

• Conduct coverage reviews based on member plan benefits and national and proprietary coverage review policies, render coverage determinations.
• Document clinical review findings, actions, and outcomes per policies and regulatory/accreditation requirements.
• Engage with requesting providers in peer-to-peer discussions as needed.
• Interpret existing benefit language and policies during clinical coverage reviews.
• Participate in daily clinical rounds as requested.
• Communicate with network and non-network providers to ensure accurate and timely benefit determinations, and educate on benefit plans and medical policy.
• Collaborate with internal partners and participate in holiday/call coverage rotation.

Skills

Evidence Based Medicine

MS Word, Outlook, Excel

Education

MD or DO

Board certification in Sleep Medicine

Job description

UnitedHealth Group’s Optum division seeks a Medical Director to provide physician support for Enterprise Clinical Services, overseeing pre-service benefit determinations and clinical coverage reviews to optimize care and cost efficiency. You will collaborate with network and non-network physicians and cross-functional teams to ensure compliant, evidence-based decisions.

The role emphasizes leadership in utilization management, communication, and continuous improvement within a remote-work