UM Medical Director - Pediatrics and Internal Medicine - 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
• Participate in holiday and call coverage rotation

Required Qualifications

• M.D. or D.O., Board certification in Internal Medicine and Pediatrics through the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA)
• 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

• 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
• Proven innovative problem-solving skills
• Proven presentation skills for both clinical and non-clinical audiences

Benefits

Comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution (all benefits are subject to eligibility requirements).

Pay

The salary for this role will range from $248,500 - $373,000 annually based on full-time employment.

Equal Opportunity Employer

We comply with all minimum wage laws as applicable. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified candidates 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.