UM Medical Director DME - Pacific or Mountain Time Zone preferred - Remote

UM Medical Director, DME – Remote (Pacific or Mountain Time Zone preferred) – Optum

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. We aim to improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. This role empowers providers and members by improving care, reducing variation, delivering seamless experience, and managing health care costs.

The Medical Director provides physician support to Enterprise Clinical Services operations, overseeing initial clinical review of service requests. The director collaborates with leadership to establish, implement, support, and maintain clinical and operational processes related to benefit coverage determinations, quality improvement, and cost-effectiveness. Responsibilities include applying clinical knowledge in utilization management activities, primarily pre-service benefit and coverage determination, and communicating with network and non-network physicians.

The Medical Director works with a multidisciplinary team to manage medical benefits across all lines of business, ensuring cost-effective, high-quality care for members.

Travels may be required; remote work is available from anywhere within the U.S. (Minneapolis or Washington, DC hires must work in the office at least four days per week).

Primary Responsibilities

• Conduct coverage reviews based on member plan benefits and national proprietary policies, rendering coverage determinations.
• Document clinical review findings, actions, and outcomes in accordance with policies, regulatory and accreditation requirements.
• Engage with requesting providers as needed in peer-to-peer discussions.
• Interpret benefit language and policies during coverage reviews.
• Participate in daily clinical rounds as requested.
• Collaborate with network and non-network providers to ensure accurate, timely benefit determinations and educate providers on benefit plans.
• Coordinate with internal partners.
• Manage coverage rotation call schedule.

Required Qualifications

• M.D. or D.O.
• Active unrestricted medical license.
• Board certification in Physical Medicine & Rehabilitation, Internal Medicine, Emergency, or Family Medicine.
• 3+ years of clinical practice experience post-residency.
• Sound knowledge of Evidence Based Medicine.
• Proficient PC skills (MS Word, Outlook, Excel).

Preferred Qualifications

• Multiple state licenses.
• Experience in utilization and clinical coverage review.
• Data analysis and interpretation aptitude.
• Excellent oral, written, and interpersonal communication skills; facilitation skills.
• Strong presentation skills for clinical and non-clinical audiences.
• Reside in Pacific or Mountain Time Zone.

Telecommuter Policy – All remote employees must adhere to UnitedHealth Group’s Telecommuter Policy.

Benefits and Compensation – Salary range: $248,500–$373,000 per annum, based on local labor market, education, experience, and certifications. Additional benefits include a comprehensive benefits package, incentive and recognition programs, equity stock purchase opportunity, and 401(k) contribution (eligibility applies).

Application Deadline – The posting remains open for at least two business days or until a sufficient candidate pool is collected. Hiring may close early due to high volume.

EEO Statement

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.

Drug-Free Workplace Statement

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Location: Phoenix, AZ (Remote, with preference for Pacific or Mountain Time Zone; Minneapolis or Washington, DC hires required to work in office at least four days per week).

For reasonable accommodations in the application process, call View phone number on click.appcast.io during Recruitment Services hours (7 a.m. to 7 p.m. CT, Monday through Friday).