Remote Utilization Management Medical Director

ISHE; Boston, Northern (MA, KY); Hybrid; USD 249,000 - 373,000; Full time

Benefits offered by this job

Comprehensive benefits

Equity stock purchase

401k contribution

Remote work policy

Job summary

UnitedHealth Group seeks a Medical Director to lead clinical coverage reviews and benefit determinations within Enterprise Clinical Services. You will collaborate with leadership to implement processes, educate providers, and ensure cost-effective, high-quality care for members.

The role emphasizes clinical knowledge, communication, and remediation of utilization management. You can work remotely from anywhere in the United States, with responsibilities spanning holidays and on-call rotation as

Qualifications

• MD or DO with full medical license and board certification.
• Experience in utilization management and clinical reviews.
• Proven ability to perform coverage determinations and communicate findings.

Responsibilities

• Conduct coverage reviews based on member plan benefits and policies.
• Document and communicate clinical review findings and outcomes.
• Engage with providers in peer-to-peer discussions as needed.
• Interpret benefit language in clinical coverage reviews and participate in rounds.
• Collaborate with network and non-network providers to ensure timely determinations.

Skills

Clinical practice

Evidence Based Medicine

MS Word

Outlook

Excel

Communication

Call coverage

Education

MD or DO

ABMS or AOA board certification

Active unrestricted medical license

Tools

MS Word

Outlook

Excel

Job description

UnitedHealth Group seeks a Medical Director to lead clinical coverage reviews and benefit determinations within Enterprise Clinical Services. You will collaborate with leadership to implement processes, educate providers, and ensure cost-effective, high-quality care for members.

The role emphasizes clinical knowledge, communication, and remediation of utilization management. You can work remotely from anywhere in the United States, with responsibilities spanning holidays and on-call rotation as