Medical Director of Clinical Advocacy and Support Services

Join Optum, a global organization dedicated to improving health outcomes through the power of technology and personalized care. Our mission is to assist millions in living healthier lives while fostering a culture of inclusion, collaboration, and personal growth. In this role, you will make a significant impact on communities by advancing health optimization on a global scale. The Clinical Advocacy & Support team is committed to enhancing the customer journey and exceeding expectations in clinical coverage and medical claims reviews. We empower both providers and members with essential tools and information to improve health outcomes, manage healthcare costs, and ensure a seamless experience. As the Medical Director, you will play a vital role in supporting Enterprise Clinical Services operations, which oversee initial clinical reviews of service requests. You will work closely with leadership and staff to establish, implement, and streamline processes related to benefit coverage determinations, quality improvement, and service effectiveness for our members. Your focus will include applying clinical knowledge to utilization management, particularly in pre-service benefit determinations and communicating these processes to both network and non-network physicians. This role involves collaboration with a multidisciplinary team and active participation in managing medical benefits, ensuring that members receive appropriate and cost-effective quality care. Key Responsibilities: Conduct comprehensive coverage reviews based on individual member plans and established policies, delivering accurate benefit determinations. Document clinical review outcomes and findings in compliance with policies and regulatory requirements. Engage in peer-to-peer discussions with requesting providers as necessary. Interpret existing benefit language and clinical policies accurately during reviews. Participate in daily clinical rounds as needed. Communicate and collaborate with network and non-network providers to ensure timely and accurate benefit determinations while educating them on medical policies. Collaborate effectively with internal partners to enhance service delivery. Participate in call coverage rotation as required. You will be rewarded for your performance in an environment that promotes challenges and clarity on success pathways. We also provide opportunities for your professional development to prepare you for future roles you may aspire to. Qualifications: M.D. or D.O. degree Active, unrestricted medical license Board certification in an ABMS specialty, with preference for Internal Medicine, Family Medicine, Hematology-Oncology, General Surgery, Rheumatology, or PM&R A minimum of 3 years of clinical experience following residency Strong understanding of Evidence-Based Medicine (EBM) Proficient with MS Word, Outlook, and Excel Preferred Experience: Previous experience with utilization and clinical coverage review Exceptional oral, written, and interpersonal communication skills Aptitude for data analysis and interpretation Innovative problem-solving abilities Strong presentation skills for both clinical and non-clinical audiences Remote work flexibility is available for this position, and we strive to foster an inclusive workplace where everyone can thrive. We follow the UnitedHealth Group Telecommuter Policy for all remote employees. Salary:

The salary range for this role will be between $269,500 and $425,500 annually, based on experience, education, and local labor markets. Our comprehensive benefits package includes various incentives and a 401(k) plan. Application Deadline:

This position will be posted for a minimum of 2 business days or until a sufficient candidate pool is gathered. At UnitedHealth Group, we are dedicated to ensuring equitable healthcare for all individuals while recognizing and addressing health disparities. Join us in making a difference. We are an Equal Employment Opportunity employer and welcome applications from all qualified individuals, without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or veteran status. This position requires passing a drug test prior to employment.