Clinical Review Medical Director - Neurology - Remote

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
• Call coverage rotation

Required Qualifications

• M.D or D.O.
• Active unrestricted license to practice medicine
• Board Certification in Neurology through the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA)
• 5+ years of clinical practice experience after completing residency training
• Sound understanding of Evidence Based Medicine (EBM)
• Proven solid PC skills, specifically using MS Word, Outlook, and Excel

Preferred Qualifications

• Licensed in MA or MN
• Utilization Management or clinical coverage review experience for an insurance or managed care organization
• Proven data analysis and interpretation aptitude
• Proven innovative problem-solving skills
• Demonstrated excellent presentation skills for both clinical and non-clinical audiences
• Demonstrated excellent oral, written, and interpersonal communication skills, facilitation skills
• Willing to obtain additional licensures if needed

Compensation

Compensation for this specialty generally ranges from $248,500.00 to $373,000.00. 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.

Benefits

• A comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution (all benefits are subject to eligibility requirements)

UnitedHealth Group Commitment

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.