Note: The job is a remote job and is open to candidates in USA. UnitedHealth Group is a global organization that delivers care through technology to improve health outcomes. The Medical Director will provide physician support for clinical operations, focusing on coverage determinations and collaborating with a multidisciplinary team to ensure effective medical care for members.
Responsibilities
- Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, 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
- 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 holiday and call coverage rotation
Skills
- M.D or D.O
- Board certification in Internal Medicine and Pediatrics 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
- 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
- Ability to participate in rotational holiday and call coverage
- Experience in utilization and clinical coverage review
- Reside in Nebraska or Texas
- Licensure in TX. IN, KS, NE, AZ, WA, FL or a compact license
- Proven excellent oral, written, and interpersonal communication skills, facilitation skills
- Demonstrated data analysis and interpretation aptitude
- Proven innovative problem-solving skills
- Demonstrated presentation skills for both clinical and non-clinical audiences
Benefits
- A comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution (all benefits are subject to eligibility requirements)
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