Clinical Advocacy and Support Medical Director

1 week ago

Fort Wayne, Indiana, United States UnitedHealth Group Full time
About the Role

We are seeking a highly skilled Medical Director to join our team at UnitedHealth Group. As a key member of our Enterprise Clinical Services operations, you will play a critical role in ensuring the delivery of high-quality clinical coverage and medical claims reviews.

Key Responsibilities
  • Conduct thorough coverage reviews based on individual member plan benefits and national and proprietary coverage review 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 to ensure accurate and timely benefit determinations.
  • Be knowledgeable in interpreting existing benefit language and policies in the process of clinical coverage reviews.
  • Participate in daily clinical rounds as requested to stay up-to-date on clinical best practices.
  • Communicate and collaborate with network and non-network providers to educate them on benefit plans and medical policy.
  • Collaborate with other internal partners to ensure seamless communication and coordination.
Requirements
  • M.D. or D.O. degree.
  • Active unrestricted license to practice medicine.
  • Board certification approved by the American Board of Medical Specialties (ABMS).
  • 5+ years of clinical practice experience after completing residency training.
  • Solid understanding of Evidence-Based Medicine (EBM).
  • Proven PC skills, specifically using MS Word, Outlook, and Excel.
Preferred Qualifications
  • Current licensure in New Mexico, Arizona, Texas, or Tennessee.
  • Board Certification in Internal Medicine, Surgery, or Plastic Surgery.
  • Experience in utilization and clinical coverage review.
  • Proven data analysis and interpretation aptitude.
  • Proven innovative problem-solving skills.
  • Excellent presentation skills for both clinical and non-clinical audiences.
  • Excellent oral, written, and interpersonal communication skills, facilitation skills.
About UnitedHealth Group

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.

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