Medical Claims Review Medical Director – Pain Medicine or Anesthesiology – Remote (USA)
Location: Remote, United States (Primary Location: Eden Prairie, MN)
Job Category: Medical and Clinical Operations
Requisition Number: 2337930
Employment Type: Full-Time
Overview
Optum, part of UnitedHealth Group, is a global healthcare organization delivering technology-enabled care, pharmacy benefit solutions, and data-driven clinical services to improve patient outcomes. The organization focuses on enhancing access to quality care, optimizing healthcare delivery, and ensuring cost-effective medical benefit management across diverse populations.
The Medical Claims Review Medical Director – Pain Medicine or Anesthesiology is a senior-level physician leadership role within Enterprise Clinical Services. This remote opportunity is designed for experienced board-certified physicians seeking to transition into utilization management, payer-side medical review, or healthcare operations leadership.
Role Summary
The Medical Director provides clinical oversight for medical claims review, post-service coverage determinations, and medical necessity evaluations. The position supports Enterprise Clinical Services in reviewing service requests and ensuring benefit determinations align with member plan documents, regulatory requirements, and evidence-based medical guidelines.
This role requires specialized expertise in Pain Medicine or Anesthesiology, combined with strong knowledge of utilization review processes, clinical documentation standards, and healthcare cost management principles. The Medical Director collaborates closely with internal clinical teams, operational leadership, and external healthcare providers to ensure accurate, compliant, and timely decisions.
Key Responsibilities
Conduct medical necessity reviews and coverage determinations based on individual member benefit plans and national or proprietary clinical policies.
Apply evidence-based guidelines and specialty-specific expertise in Pain Medicine or Anesthesiology to utilization management decisions.
Document clinical findings, determinations, and outcomes in accordance with regulatory, accreditation, and internal compliance standards.
Engage in peer-to-peer discussions with requesting physicians to clarify clinical rationale and ensure appropriate care decisions.
Interpret and apply benefit language and coverage policies during claims review processes.
Participate in daily clinical rounds and case discussions as required.
Collaborate with multidisciplinary teams to support quality improvement initiatives and cost-containment strategies.
Communicate effectively with network and non-network providers to ensure timely and accurate benefit determinations.
Required Qualifications
Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO).
Active, unrestricted license to practice medicine in the United States.
Board Certification in Pain Medicine or Anesthesiology.
Minimum 5+ years of post-residency clinical practice experience in Pain Medicine or Anesthesiology.
Demonstrated expertise in Evidence-Based Medicine (EBM).
Proficiency in Microsoft Office applications including Word, Outlook, and Excel.
Preferred Qualifications
Active medical license in Texas or California.
Interstate Medical Licensure Compact participation.
Prior experience in utilization review, medical claims review, or payer-side clinical operations.
Strong analytical and data interpretation skills.
Proven problem-solving and clinical decision-making abilities.
Excellent written, verbal, and interpersonal communication skills.
Residence within Pacific Standard Time (PST) or Mountain Standard Time (MST) preferred.
Work Arrangement
This is a fully remote position within the United States. All remote employees must comply with the organization’s telecommuting and operational policies.
Compensation and Benefits
The compensation range for this specialty generally falls between USD 248,500 and 373,000 annually, including base salary and performance-based incentives. Total compensation is determined by experience, education, geographic labor market, and productivity metrics.
The organization offers a comprehensive benefits package that may include medical, dental, and vision coverage, retirement savings plans with employer contributions, equity stock purchase programs, incentive and recognition programs, and professional development opportunities. Eligibility requirements apply.
Application Timeline
This position will be posted for a minimum of two business days or until a sufficient candidate pool has been established. The posting may close earlier depending on application volume.
Gujarat :
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Bilaspur | Eot Municipality | Raipur |Uttarakhand :
Dehradun | Halifax | Nainital | Rishikesh | Roorkee |Delhi :
Delhi | India | New Delhi | PAN-India |Assam :
Dibrugarh | Diburghar | Guwahati |West Bengal :
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Hajipur | Patna |Kerala :
Kannur | Kochi | Malappuram | Thiruvananthapuram | Trivandrum |Pondicherry (Puducherry) :
Pondicherry (Puducherry) |Jharkhand :
Ranchi |Sikkim :
Rangpo |India :
Siliguri |Illinois :
Abbott Park | Bloomingdale | Champaign | Chicago | Deerfield | Glenview | Lake Forest | Lombard | Naperville | Norridge | Park RIdge | Round Lake |Maryland :
Aberdeen | Baltimore | Bel Air | Cheverly | Columbia | Elkridge | Gaithersburg | Largo | Linthicum | Rockville | Towson | Upper Marlboro | White Plains |Texas :
Abilene | Arlington | Austin | Boerne | Brenham | Bulverde | Carrollton | Cedar Hill | Corpus Christi | Corsicana | Dallas | Denton | El Paso | Fort Worth | Garland | Houston | Lakeway | Longview | Mcallen | North Richland Hills | Plano | Richardson | San Antonio | Seguin | Tyler | Waco |California :
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Albuquerque | Farmington | Santa Fe | Tucumcari |Pennsylvania :
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Anchorage | Barrow | Bethel | Juneau | Sitka | Wrangell |Massachusetts :
Andover | Billerica | Boston | Cambridge | Devens | Lexington | Massachusetts | Medford and Somerville | Rockland |Wisconsin :
Appleton | Kenosha | Pleasant Prairie | Portage | Waukesha |United states :
Arizona | Buffalo Grove | Clayton | Downers Grove | fairmont | Georgia | Keene | Michigan | Mt. Pleasant | New Jersy | OH | Piedmont | Salisbury | United States | Whitesboro | Winston-Salem |Georgia :
Atlanta | Augusta | Rome |Maine :
Bangor | Brewer |New Jersey :
Basking Ridge | Bloomfield | Branchburg Township | Bridgewater | Brunswick | Burlington | Charlotte | Clark | Cranbury | Dunellen | East Brunswick | Edison | Fairfield | Far Hills | Flemington | Hackensack | Hopewell | Indianapolis | Jersey City | Linden | Livingston | Lyndhurst | Mahwah | Monmouth Junction | Montville | Mount Arlington | Newark | New Brunswick | Nutley | Paramus | Parsippany | Passaic | Paterson | Peapack-Gladstone | Pine Brook | Piscataway Township | Plainsboro | Princeton Junction | Rahway | Raritan | Somerset | Somerville | South Plainfield | Sparta | Summit | Titusville | Trenton | Warren Grove | Westfield | West Orange | Wharton | Whippany |Ohio :
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Baton Rouge | Monroe | New Orleans |Washington :
Bellevue | Bothell | Friday Harbor | Goldendale | Mount Vernon | Pullman | Seattle | Sherwood | Tacoma | Vancouver |Oregon :
Bend | Coquille | Corvallis | Eugene | Florence | Grants Pass | John Day | Lake Oswego | Lakeview | Portland | Reedsport | Roseburg | Salem | Springfield | Woodburn |Wyoming :
Big Piney | Cokeville |Alabama :
Birmingham |Virginia :
Blacksburg | Charlottesville | Falls Church | Mechanicsville |Indiana :
Bloomington | West Lafayette |Florida :
Boca Raton | Brooksville | Clearwater | Cooper City | Coral Gables | Coral Springs | Daytona Beach | Florida | Gainesville | Hollywood | Jacksonville | Maitland | Marsa | Miami | Naples | North Miami Beach | Orlando | Pembroke Pines | Plantation | Port St. Lucie | Rueil-Malmaison | Saint Petersburg | Sarasota | Stuart | Tallahassee | Tampa | West Palm Beach | Winter Haven |Idaho :
Boise |Colorado :
Boulder | Denver | Westminster |Connecticut :
Bridgeport | Bristol | Enfield | Groton | Hartford | New Haven | Newtown | South Windsor | Stamford | Storrs | West Hartford |North Caroline :
Carolina Beach | Chapel Hills | Durham | Holly Springs | Morrisville | Philippines | Raleigh | Rocky Mount | Sanford | Scottsdale |Arizona :
Chandler | Kingman | Lake Havasu City | Mesa | Peridot | Phoenix | Surprise | Tempe | Tucson | Yuma |South Carolina :
Charleston |Kansas :
Chengdu | Garden city | Kansas City | Lawrence | McPherson |North Carolina :
Concord | Lumberton | North Carolina |Michigan :
Detroit | Houghton Lake | Macomb | Southfield |North Dakota :
Dickinson |Minnesota :
Duluth | Eden Prairie | Fridley | Hibbing | Maple Grove | Minneapolis and St. Paul, Minnesota. | Minnetonka | St.Paul |Kentucky :
Edgewood | Ft MItchell | Louisville | Shelbyville |Arkansas :
Fort Smith |Kington :
Frank Scottile Blvd |Missouri :
Fulton | Milan | St. Louis |United States :
Hawai | kentucky | Sylmar | Woonsocket |Nebraska :
Hebron | Nebraska City |Hawaii :
Hilo | Honolulu |Tennessee :
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Lake Charles | Shreveport |Nevada :
Las Vegas | Tonopah | Tonopsh | Virginia |New Hampshire :
Lebanon | Macon | Manchester |Portugal :
Lisbon | Oeiras | Portugal |WI :
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Oklahoma City |Puerto Rico :
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Bavaria |Bavaria :
Bayreuth | Erlangen | Munich | Regensburg | Wurzburg |Brandenburg :
Berlin |Baden-Wurttemberg :
Biberach an der Riß | Freiburg | Grenzach | Heidelberg | Karlsruhe | Konstanz | Stuttgart | Tubingen | Ulm |Hesse :
Darmstadt | Marburg |Hessen :
Frankfurt | Harveysburg |Germany :
Germany | GErmany |Lower Saxony :
Gottingen | Hannover | Leipzig |Saxony Anhalt :
Halle |Rotherbaum :
Hamburg |Rhineland Palatinate :
Ingelheim am Rhein | Mainz |Schleswig Holstein :
Kiel |Berlin :
Mitte |Mecklenburg Vorpommern :
Rostock |Saarland :
Saarbrucken |Switzerland :
Basel | Zurich |Serbia :
Belgrade | Serbia |Hungary :
Budapest |BULGARIA :
Bulgaria | Vedant |Denmark :
Copenhagen | Denmark |Europe :
Europe | France | Latvia | Lendava | Leuven | Poland | Slovenia | Spain |Finland :
Finland |Istanbul :
Istanbul | Turkey |Norway :
Norway | NOrway |Romania :
Romania |Belgium :
Wavre |Tipperary :
Ballydine |Cork :
Brinny | Ringaskiddy |Carlow :
Carlow |Republic of Ireland :
Cork | Dublin | Limerick | Waterford |Ulster :
Donegal |Meath :
Dunboyne |Dún Laoghaire :
Dún Laoghaire |Galway :
Galway |County Dublin :
Swords |Republic of China :
Beijing |China :
China | Quarry Bay |Liaoning :
Dalian |Zhejiang :
Hangzhou |Tokiyo :
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Shanghai Shi |Hubei :
Wuhan |Capital of Netherland :
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Leiden |Netherlands :
Netherlands |Remote Australia :
Arkansas | Remote Australia |New South Wales :
Ballina | Sydney |Republic of Western Australia :
Nedlands |Queensland :
Queensland |Melbourne :
South Yarra |United Kingdom :
England | Harlow | Leeds | London | Maidenhead | Salt Lake City | Stevenage | Stirling | United Kingdom |North Yorkshire :
Harrogate |South Yorkshire :
Sheffield |Oxfordshire :
Witney |Ontario :
Richmond Hill | Uxbridge | North York | Mississauga | Australia | Renfrew |Canada :
Canada |Quebec :
Montreal |Brussels :
Brussels |Antwerp :
Heist op den Berg |Flemish Brabant :
Zaventem |South America :
Peru | Argentina |Brazil :
Brazil | Sao paulo |Attica :
Athens | Koropi |Greece :
Greece |North Island :
Auckland |New Zealand :
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Austria |Vienna :
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Barcelona |Madrid :
Madrid |Cebu Province :
Cebu City |Philippines :
Manila |Croatia :
Croatia |Zagreb :
Zagreb |Estonia :
Estonia | Tartu |Harju County (Maakond) :
Tallinn |Hà Nội :
Hanoi | Hà Nội |Ho Chi Minh :
Ho Chi Minh City |Italy :
Italy |Lombardy :
Rho |Jakarta :
Jakarta |East Java :
Surabaya |Japan :
Saitama | Japan |Tokyo :
Otemachi |North Ostrobothnia :
Oulu |Southwest Finland (Varsinais-Suomi) :
Turku |Remote Korea :
Remote Korea |Republic of Korea :
Seoul |Kazakhstan :
Almaty |Republic of Thailand :
Bangkok |Israel :
Netanya | Yavne | Be'Er Sheva | Kfar Saba | Tel Aviv |Remote :
Minnesota | Switzerland | Leinster | Thailand | Nairobi | Tulsa | Blue Bell | Zaragoza | Regulatory Labeling Manager (NA and LATAM Only) | Remote | Hammond | French | Lenexa | Green Way | Victoria | Manipal | Springville | Xzagreb | Remote - Middle East | Remote - South America (Latin Americal) | Ireland | McFarland | Faridabad | Remote - Africa | Bishop | Bountiful | Texas | Lousiana | Riga | Remote - Europe | Slovakia | Medan | Melbourne | Hungary | Belgium | Castlebar | Remote, USA |Republic of Colombia :
Bogota |Williamson :
Brentwood |Bucharest :
Bucharest |Buenos Aires :
Buenos Aires |Republic of Egypt :
Cairo |Mexico :
New Mexico | Ciudad de México |Dubai :
Dubai |Makkah :
Najran | Rabigh | Riyadh | Jeddah | Khulais | King Abdullah Economic City |Kuala Lumpur :
Kuala Lumpur |Kyiv Oblast :
Kyiv |Lima Region :
Lima |France :
Lyon | Paris |South Africa :
South Africa | Midrand |Nišava District :
Niš |Bohemia :
Prague |Chile :
Santiago |Bosnia and Herzegovina :
Sarajevo |Singapore :
Singapore |Sofia City :
Sofia |Sweden :
Sweden |Taipei :
Taipei |Mazovia :
Warsaw |
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