Medical Director – Utilization Management (Florida License Required) | Remote (Florida, USA)
Requisition Number: 2317652
Category: Medical and Clinical Operations
Primary Location: Orlando, Florida, United States
Work Model: Remote (for Florida residents)
Position Overview
Optum, a global leader in healthcare delivery and technology-enabled clinical solutions, is recruiting a Medical Director – Utilization Management licensed and residing in Florida. This role supports the Enterprise Clinical Services division, providing expert clinical oversight for coverage reviews, benefit determinations, and quality improvement initiatives.
The Medical Director will contribute directly to improving health outcomes, enhancing care quality, and supporting cost-effective utilization of medical services. Candidates must currently live in Florida and hold an active Florida medical license.
Key Responsibilities
Conduct clinical coverage reviews based on member benefits, national guidelines, and proprietary policies.
Render final benefit determinations and ensure compliance with regulatory documentation standards.
Participate in peer-to-peer discussions with requesting providers when clinical clarification is required.
Interpret and apply benefit language accurately during coverage assessments.
Join multidisciplinary clinical rounds as requested.
Collaborate with network and non-network providers to support timely and accurate determinations.
Educate providers on medical policies, coverage guidelines, and benefit structures.
Coordinate with internal teams to support effective clinical operations.
Participate in rotational weekend and holiday coverage.
Required Qualifications
Doctor of Medicine (MD) or Doctor of Osteopathy (DO).
Active, unrestricted Florida medical license with no disciplinary restrictions.
Board certification in Internal Medicine or Family Practice.
Minimum 5 years of post-residency clinical practice experience.
Strong experience using electronic clinical systems.
Demonstrated understanding of Evidence-Based Medicine (EBM) and current clinical practices.
Proficiency in MS Word, Outlook, and Excel.
Ability to participate in rotational weekend and holiday call coverage.
Must currently reside in Florida.
Preferred Qualifications
Hands-on experience in utilization review or clinical coverage review.
Clinical practice experience within the last 2 years.
Experience in data analysis and data interpretation.
Working knowledge of managed care principles.
Strong presentation and communication skills for clinical and non-clinical audiences.
Compensation and Benefits
Annual compensation range: USD 238,000 – 357,500, including base pay and performance-based bonus.
Pay varies according to labor market factors, experience, education, and productivity.
Comprehensive benefits package, including:
Health and wellness benefits
Incentive and recognition programs
Equity stock purchase options
401(k) contribution program
Additional benefits based on eligibility
Work Environment
This position is remote for candidates residing in Florida and adheres to UnitedHealth Group’s Telecommuter Policy.
The role remains posted for a minimum of two business days or until candidate volume is sufficient.
About UnitedHealth Group
UnitedHealth Group is committed to making healthcare work better for everyone. The organization promotes equitable access to care, supports underserved communities, and complies with all federal, state, and local employment regulations. All qualified applicants receive equal consideration regardless of protected characteristics.
UnitedHealth Group is a drug-free workplace. Candidates must pass a drug test prior to employment.
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