Senior Medical Director, Remote AI-Driven UM

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

Benefits offered by this job

Equity stock purchase

401k contribution

Job summary

UnitedHealthcare is seeking a Medical Director, Clinical AI Innovation and Performance to lead clinical annotation, training and testing for UM decision support, focusing on InterQual criteria and evidence-based guidelines. This senior physician role partners with Medical Policy, Data Science and enterprise leadership to translate policy into scalable UM criteria.

Work will be performed remotely within the U.S.

Qualifications

• MD or DO with active/unrestricted U.S. medical license.
• Board certification in clinical specialty.
• Significant experience in utilization management.
• Experience with InterQual criteria and UM operations at scale.

Responsibilities

• Lead clinical annotation and model training for UM decision support.
• Translate policy into UM ready clinical criteria.
• Oversee qualification interpretation for safe, effective coverage decisions.
• Collaborate with Medical Policy, data science and UX leadership.

Skills

Utilization management

InterQual criteria

Clinical leadership

AI in healthcare

Education

MD or DO with active/unrestricted U.S. Medical Licensure

Board certification in an ABMS/AOBMS Clinical specialty

Job description

UnitedHealthcare is seeking a Medical Director, Clinical AI Innovation and Performance to lead clinical annotation, training and testing for UM decision support, focusing on InterQual criteria and evidence-based guidelines. This senior physician role partners with Medical Policy, Data Science and enterprise leadership to translate policy into scalable UM criteria.

Work will be performed remotely within the U.S.