UM Medical Director - DME - Remote in US

UnitedHealth Group•San Diego, CA

4d•$248,500 - $373,000•Remote

About The Position

The Medical Director provides physician support to Enterprise Clinical Services operations, which is responsible for initial clinical reviews of service requests. The role collaborates with Enterprise Clinical Services leadership and staff to establish, implement, support, and maintain clinical and operational processes related to benefit coverage determinations, quality improvement, and cost effectiveness of services for members. Activities focus on applying clinical knowledge to utilization management, particularly pre-service benefit and coverage determinations or medical-necessity reviews according to benefit packages, and communicating about the process with network and non-network physicians and other Enterprise Clinical Services teams. The Medical Director works with a multidisciplinary team and helps manage medical benefits across all lines of business, often in collaboration with a member’s primary care provider or specialist. The role is responsible for ensuring members receive appropriate, cost-effective, quality medical care. The position is remote within the U.S.; employees hired in the Minneapolis or Washington, D.C. areas must work in the office at least four days per week. Working in Pacific Standard Time is preferred, and remote employees must follow UnitedHealth Group’s Telecommuter Policy.

Requirements

M.D. or D.O.
Active, unrestricted license to practice medicine.
Board certification in Physical Medicine & Rehabilitation, Internal Medicine, Family Medicine, general surgery, or orthopedic surgery under an American board or AOA board certification.
At least 5 years of clinical practice experience after completing residency training.
Sound understanding of Evidence Based Medicine (EBM).
Solid PC skills, specifically using MS Word, Outlook, and Excel.

Nice To Haves

Multiple state licenses.
Experience in utilization and clinical coverage review.
Aptitude for data analysis and interpretation.
Innovative problem-solving skills.
Excellent oral, written, and interpersonal communication skills and facilitation skills.
Excellent presentation skills for clinical and non-clinical audiences.
Residence in the Pacific Time Zone.

Responsibilities

Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, and render 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.
Interpret existing benefit language and policies during clinical coverage reviews.
Participate in daily clinical rounds as requested.
Communicate and collaborate with network and non-network providers to support accurate and timely benefit determinations and educate providers on benefit plans and medical policy.
Communicate and collaborate with internal partners.
Participate in a call coverage rotation.
Collaborate with Enterprise Clinical Services leadership and staff on clinical and operational processes related to benefit coverage determinations, quality improvement, and cost effectiveness.
Help ensure members receive appropriate, cost-effective, quality medical care.