Medical Director – Clinical Advocacy & Support (Remote)
Company: Optum (UnitedHealth Group)
Location: Honolulu, HI (Remote across the U.S.)
Compensation: $238,000 – $357,500 annually (full-time)
Work Mode: Remote
Job Summary
Optum is hiring a Medical Director – Clinical Advocacy and Support to oversee clinical coverage reviews, benefit determinations, and medical claims assessments. This role is ideal for board-certified physicians with experience in Internal Medicine, ENT, or related specialties, aiming to apply evidence-based medicine principles to enhance quality, cost-effectiveness, and care equity across the healthcare system. The position offers a fully remote setup, collaborating with internal and external healthcare stakeholders to drive improved outcomes.
Responsibilities
Conduct clinical coverage reviews using member plan benefits, national standards, and proprietary policies.
Document review findings and benefit determinations per regulatory requirements.
Engage in peer-to-peer discussions with providers to ensure clarity on medical necessity and coverage.
Participate in daily clinical rounds as needed.
Collaborate with network and non-network providers to provide accurate and timely benefit decisions.
Educate providers on medical policy and benefit plan coverage.
Handle call coverage rotations and cross-functional communication.
Required Skills & Qualifications
M.D. or D.O. with active unrestricted medical license.
Board certification in Internal Medicine, ENT, Hematology-Oncology, General Surgery, Rheumatology, or PM&R (preferred).
Minimum 3+ years of post-residency clinical practice experience.
Strong understanding of Evidence-Based Medicine (EBM).
Proficiency in MS Word, Excel, and Outlook.
Preferred Qualifications
Licensure in CA, OR, WA, or AZ (or willingness to obtain).
Experience in clinical coverage review or utilization management.
Excellent communication, data analysis, and problem-solving skills.
Strong presentation skills for clinical and non-clinical audiences.
Perks & Benefits
Competitive salary of $238,000–$357,500 annually.
Comprehensive health, dental, and vision insurance.
401(k) with company contribution, equity stock purchase plans.
Incentive and recognition programs.
Opportunities for career growth and leadership roles within UnitedHealth Group.
Company Description
Optum, part of UnitedHealth Group, is a global leader in healthcare services, clinical innovation, and digital health solutions. The company empowers providers and patients with tools and insights to improve health outcomes, reduce care variability, and enhance cost-efficiency across diverse care settings.
Work Mode: Remote (U.S.)
Call-to-Action
If you are a board-certified physician seeking a leadership role in clinical advocacy, coverage review, and quality improvement, apply today and join Optum’s mission to make healthcare smarter and more accessible.
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