UM Medical Director - Surgical Specialty - Remote
About The Position
The Medical Director provides physician support to Enterprise Clinical Services, which conducts initial clinical reviews of service requests. The role partners with leadership and staff to establish and maintain clinical and operational processes for benefit coverage determinations, quality improvement, and cost-effective services. Work focuses on applying clinical knowledge to utilization management, particularly pre-service benefit and coverage determinations and medical-necessity reviews based on the member’s benefit package. The Medical Director communicates with network and non-network physicians and other Enterprise Clinical Services teams. Working with a multidisciplinary team and often a member’s primary care or specialist physician, the Medical Director helps manage medical benefits and ensures members receive appropriate, high-quality, cost-effective care. The position is remote from anywhere in the U.S. Remote employees must follow UnitedHealth Group’s Telecommuter Policy.
Requirements
- M.D. or D.O.
- Board certification in any surgical specialty through the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA).
- Active unrestricted medical license and ability to obtain additional state medical licenses as needed.
- 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.
- Ability to participate in rotational holiday and call coverage.
Nice To Haves
- Experience in utilization and clinical coverage review.
- Reside in Nebraska or Texas.
- Licensure in Texas, Indiana, Kansas, Nebraska, Arizona, Washington, or Florida, or a compact license.
- Excellent oral, written, and interpersonal communication skills and facilitation skills.
- Data analysis and interpretation aptitude.
- Innovative problem-solving skills.
- Presentation skills for clinical and non-clinical audiences.
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 in peer-to-peer discussions as needed.
- 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 about benefit plans and medical policy.
- Communicate and collaborate with internal partners.
- Participate in holiday and call coverage rotation.
Benefits
- Comprehensive benefits package, subject to eligibility requirements.
- Incentive and recognition programs.
- Equity stock purchase.
- 401(k) contribution.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
Ph.D. or professional degree
