Medical Director Utilization Management - Remote

You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy. Primary 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 Required Qualifications M.D or D.O. Active board certification in an ABMS or AOBMS specialty 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 Preferred Qualifications Board certification in either Gastroenterology, Cardiology, Endocrinology, radiation oncology (other specialties will be considered) 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 Compensation Compensation for this specialty generally ranges from $248,500 to $373,000. Total cash compensation includes base pay and bonus and is based on several factors including but not limited to local labor markets, education, work experience and may increase over time based on productivity and performance in the role. We comply with all minimum wage laws as applicable. In addition to your salary, we offer benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far‑reaching choice of benefits and incentives. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone of every race, gender, sexuality, age, location and income deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. 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. #J-18808-Ljbffr Optum