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About the Role

The Medical Director provides physician support to Enterprise Clinical Services operations, focusing on clinical coverage and medical claims reviews. This role empowers providers and members with tools and information to improve health outcomes, reduce care variation, deliver a seamless experience, and manage healthcare costs.

Responsibilities

• Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, rendering coverage determinations.
• Document clinical review findings, actions, and outcomes in accordance with policies, and regulatory and accreditation requirements.
• Engage with requesting providers as needed in peer-to-peer discussions.
• Be knowledgeable in interpreting existing benefit language and policies in the process of clinical coverage reviews.
• Participate in daily clinical rounds as requested.
• Communicate and collaborate with network and non-network providers in pursuit of accurate and timely benefit determinations for plan participants while educating providers on benefit plans and medical policy.
• Communicate and collaborate with other internal partners.
• Participate in occasional holiday and call coverage rotation.

Requirements

• M.D or D.O
• Board certification in Physical Medicine & Rehabilitation or Internal Medicine
• Active unrestricted license to practice medicine
• 5+ years of clinical practice experience after completing residency training
• Proven sound understanding of Evidence Based Medicine (EBM)
• Proven solid PC skills, specifically using MS Word, Outlook, and Excel
• All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
• Candidates are required to pass a drug test before beginning employment.

Skills

• Experience with DME
• Experience in utilization and clinical coverage review
• Excellent oral, written, and interpersonal communication skills
• Data analysis and interpretation aptitude
• Innovative problem-solving skills
• Presentation skills for both clinical and non-clinical audiences

Location

• Remote (anywhere within the U.S.)

Work Type

• Remote
• Full-time

Experience Level

• 5+ years of clinical practice experience after completing residency training

Education Level

• M.D or D.O
• Board certification in Physical Medicine & Rehabilitation or Internal Medicine

Salary/Compensations

• $248,500 - $373,000 annually

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution

About the Company

• Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives.
• The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best.
• Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities.
• Come make an impact on the communities we serve as you help us advance health optimization on a global scale.
• Join us to start Caring. Connecting. Growing together.
• At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone.
• We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life.
• Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes.
• We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

Equal Opportunity

• UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
• UnitedHealth Group is a drug - free workplace.