Remote Utilization Management Medical Director

Optum; Minneapolis (MN); On-site; USD 249,000 - 373,000; Full time

Benefits offered by this job

Remote work from anywhere in the U.S.

Job summary

Optum, a global health services company, is seeking a Medical Director to provide physician support to Enterprise Clinical Services. The role focuses on clinical coverage determinations, medical necessity reviews, and cost-effective care for members. You will collaborate with network and non-network physicians to ensure appropriate, timely decisions.

You’ll work remotely from anywhere in the U.S. Primary responsibilities include conducting coverage reviews, documenting findings, engaging with

Qualifications

• MD/DO degree required and active license
• Board certification by ABMS or AOA preferred
• Proven 5+ years of clinical practice after residency
• Solid understanding of Evidence Based Medicine (EBM)
• Proficient in MS Word, Outlook and Excel

Responsibilities

• Conduct coverage reviews based on member plan benefits and policies, render coverage determinations
• Document clinical review findings, actions, and outcomes
• Engage with requesting providers in peer-to-peer discussions as needed
• Interpret benefit language and policies during clinical reviews
• Participate in daily clinical rounds as requested
• Communicate with network and non-network providers to ensure timely and accurate determinations
• Participate in holiday and call coverage rotation

Skills

MD or DO

ABMS/AOA board certification

Active medical license

Evidence Based Medicine (EBM)

MS Word/Outlook/Excel

Holiday/call coverage

Education

MD or DO degree

Board certification ABMS or AOA

Tools

MS Word

Outlook

Excel

Job description

Optum, a global health services company, is seeking a Medical Director to provide physician support to Enterprise Clinical Services. The role focuses on clinical coverage determinations, medical necessity reviews, and cost-effective care for members. You will collaborate with network and non-network physicians to ensure appropriate, timely decisions.

You’ll work remotely from anywhere in the U.S. Primary responsibilities include conducting coverage reviews, documenting findings, engaging with