Medical Job – Remote Medical Director Role at Optum in US
This medical job offers an excellent remote job for doctors seeking leadership opportunities in utilization management. The Medical Director Utilization Management role at Optum is ideal for professionals looking for an MD job or DO job within Optum jobs and Optum careers, focused on clinical coverage review and evidence-based decision-making.
Job Details:
- Job Title: Medical Director, Utilization Management – Remote
- Requisition Number: 2341851
- Job Category: Medical & Clinical Operations
- Primary Location: Houston, TX, US (Remote considered)
About the Company:
Optum is a global healthcare organization delivering technology-enabled care solutions to improve health outcomes. Optum careers provide physicians opportunities to work in innovative, impact-driven environments across the United States.
Job Description:
This medical job involves providing physician support to Enterprise Clinical Services through utilization management and clinical coverage reviews. The Medical Director applies clinical expertise to review service requests, determine medical necessity, and collaborate with providers to ensure appropriate, cost-effective care. This remote job for doctors focuses on benefit determinations, peer-to-peer discussions, and evidence-based medical decision-making.
Qualifications:
Required Qualifications:
- M.D or D.O.
- Active board certification
- Active unrestricted medical license
- 5+ years clinical practice experience
- Strong understanding of Evidence Based Medicine
- Proficiency in MS Word, Outlook, and Excel
Preferred Qualifications:
- Specialty board certification (Gastroenterology, Cardiology, Endocrinology, Radiation Oncology)
- Experience in utilization and clinical coverage review
- Licensure in TX, IN, KS, NE, AZ, WA, FL or compact license
- Strong communication and analytical skills
Key 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
