Senior Medical Director - Utilization Management (Remote)

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

Job summary

UnitedHealth Group's Optum is hiring a Medical Director to lead clinical coverage reviews and provider collaborations across Enterprise Clinical Services. You will guide benefit determinations and support cost-effective, high-quality care for members.

You'll work remotely from anywhere in the U.S., collaborating with a multidisciplinary team, participating in holiday and call coverage, and ensuring compliance with regulatory standards while advancing evidence-based medicine and patient outcomes.

Qualifications

• MD or DO with active medical license.
• ABMS or AOA board certification.
• 5+ years of clinical practice after residency.
• Strong understanding of Evidence Based Medicine.
• Proficient in MS Word, Outlook and Excel.
• Willing to participate in holiday and call coverage.

Responsibilities

• Conduct coverage reviews based on member plan benefits and policies.
• Document clinical review findings, actions, and outcomes in accordance with policies and regulations.
• Engage with requesting providers in peer-to-peer discussions.
• Interpret benefit language in the process of clinical coverage reviews.
• Participate in daily clinical rounds as requested.
• Collaborate with network and non-network providers for determinations.

Skills

Evidence Based Medicine

MS Word

Outlook

Excel

Communication with providers

Holiday and call coverage

Education

MD/DO

Board certification ABMS or AOA

Active unrestricted medical license

5+ years clinical practice after residency

Tools

MS Word

Outlook

Excel

Job description

UnitedHealth Group's Optum is hiring a Medical Director to lead clinical coverage reviews and provider collaborations across Enterprise Clinical Services. You will guide benefit determinations and support cost-effective, high-quality care for members.

You'll work remotely from anywhere in the U.S., collaborating with a multidisciplinary team, participating in holiday and call coverage, and ensuring compliance with regulatory standards while advancing evidence-based medicine and patient outcomes.