The Medical Director provides physician support to Enterprise Clinical Services operations and collaborates with leadership and staff to establish, implement, support, and maintain clinical and operational processes related to benefit coverage determinations, quality improvement and cost effectiveness of service for members. Activities focus on clinical knowledge in utilization management, pre-service benefit and coverage determinations or medical necessity, and communication with network and non-network physicians and other Enterprise Clinical Services teams. 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 certified in Family Medicine or Internal Medicine 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 Ability to participate in call coverage rotation Preferred Qualifications: Licensed in AZ, CA, MN, TX, KY, MD or HI Utilization Management or clinical coverage review experience for an insurance or managed care organization OR 2+ years of Hospitalist Experience Proven excellent oral, written, and interpersonal communication skills, facilitation skills Proven data analysis and interpretation aptitude Proven innovative problem-solving skills Proven excellent presentation skills for both clinical and non-clinical audiences All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy. Compensation and benefits information is provided per company policy and may vary by location and experience. UnitedHealth Group is an Equal Employment Opportunity employer and prohibits discrimination and harassment of any kind. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status. Applicants must be able to pass a drug test where required. #J-18808-Ljbffr