Medical Director - Clinical Advocacy and Support (Remote)

About the role

Optum, part of UnitedHealth Group, is hiring a Medical Director for its Clinical Advocacy and Support function, which focuses on improving the use of evidence-based medicine, patient safety, practice variation and affordability. The Medical Director supports Enterprise Clinical Services, which handles the initial clinical review of service requests, and works with providers and members to improve health outcomes and control costs. The position is fully remote, from anywhere in the U.S., and specialty surgery is preferred.

Key responsibilities

• Conduct coverage reviews based on individual member plan benefits and national and proprietary policies, and render coverage determinations
• Document clinical review findings, actions and outcomes in line with policies and regulatory and accreditation requirements
• Interpret benefit language and policies during clinical coverage reviews
• Hold peer-to-peer discussions with requesting providers and communicate with network and non-network providers on accurate, timely benefit determinations
• Collaborate with internal partners and with the multidisciplinary team managing medical benefits
• Ensure the most appropriate and cost-effective quality care is provided to members
• Call coverage rotations

Required profile

• M.D. or D.O.
• Active unrestricted license to practice medicine
• Active board certification from the ABMS or the American Osteopathic Association; surgery specialties preferred, others such as physiatry, internal medicine, family or emergency medicine considered
• 3+ years of clinical practice after residency
• Solid understanding of evidence-based medicine
• Preferred: CA, OR, WA or AZ licensure or willingness to obtain it, and experience in utilization and clinical coverage review

Required skills

• Excellent PC skills, specifically MS Word, Outlook and Excel
• Preferred: data analysis and interpretation, facilitation, presentation and problem-solving skills

What we offer

• Salary of $248,500 to $373,000 annually depending on experience and other factors
• Comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution
• Development opportunities and career growth