Senior Medical Director AI-Driven Clinical Innovation & UM

UnitedHealthcare; Minnetonka (MN); On-site; USD 387,000 - 580,000; Full time

Benefits offered by this job

Comprehensive benefits package

Equity stock purchase

401k contribution

Job summary

UnitedHealthcare is seeking a Senior Physician leader to oversee clinical AI innovation and utilization management. The role drives training, testing, and surveillance of AI-enabled UM criteria, with initial focus on Prior Authorization and expansion to inpatient care and medication management.

You will collaborate with UCS leadership, medical policy, and data science teams to scale evidence-based UM across the enterprise.

Qualifications

• MD or DO with active/unrestricted U.S. Medical Licensure.
• Board certification in a clinical specialty.
• Extensive experience in utilization management at scale.

Responsibilities

• Lead clinical annotation and training for UM supporting LLM-based decision tools.
• Develop and validate evidence-based UM criteria aligned with approved medical policy.
• Ensure UM criteria function effectively in production environments across the enterprise.
• Partner with Medical Policy, Nursing, UM Operations and AI/data science teams to drive policy translation and adoption.
• Provide clinical oversight for AI-enabled clinical workflows and governance.

Skills

Utilization management

Clinical leadership

InterQual experience

AI governance familiarity

Education

MD/DO with U.S. licensure

Job description

UnitedHealthcare is seeking a Senior Physician leader to oversee clinical AI innovation and utilization management. The role drives training, testing, and surveillance of AI-enabled UM criteria, with initial focus on Prior Authorization and expansion to inpatient care and medication management.

You will collaborate with UCS leadership, medical policy, and data science teams to scale evidence-based UM across the enterprise.