Medical Director – DME | Remote (U.S.) | Optum
Requisition Number: 2315013
Job Category: Medical and Clinical Operations
Primary Location: Phoenix, Arizona, United States
Work Type: Remote (U.S. based, PST preferred)
Optum, a global leader in integrated healthcare delivery and technology-enabled clinical solutions, is hiring a Medical Director – DME to support Enterprise Clinical Services. This position offers the opportunity to influence healthcare delivery, enhance coverage review workflows, and ensure evidence-based, cost-effective care across diverse patient populations.
This remote leadership role is ideal for experienced physicians who excel in clinical decision-making, utilization management, and cross-functional collaboration within large healthcare organizations.
Role Overview
The Medical Director – DME provides expert physician support to Enterprise Clinical Services, leading clinical coverage reviews, medical necessity determinations, and benefit interpretation. The role includes close collaboration with operational leadership to enhance clinical quality, regulatory compliance, and cost-effectiveness across all lines of business.
You will work closely with providers, internal teams, and clinical reviewers to ensure accurate, timely, and evidence-based coverage decisions that support optimal patient outcomes.
Key Responsibilities
Conduct clinical and benefits-based coverage reviews in accordance with member benefit plans, national policies, and proprietary review guidelines.
Document clinical decisions, review outcomes, and actions in compliance with regulatory, accreditation, and policy requirements.
Participate in peer-to-peer discussions with requesting providers.
Interpret and apply benefit language and medical policies during clinical coverage review processes.
Engage in daily clinical rounds, as requested, to support cross-functional medical decision-making.
Collaborate with network and non-network physicians to facilitate appropriate benefit determinations and ensure clear provider education.
Partner with internal departments and Enterprise Clinical Services teams to support end-to-end review workflows.
Participate in call coverage rotations.
Required Qualifications (Experience Mandatory)
Medical Degree (MD or DO).
Active, unrestricted license to practice medicine in the United States.
Board Certification in Physical Medicine & Rehabilitation, Internal Medicine, or Family Medicine.
Minimum 5 years of clinical practice experience post-residency.
Strong understanding of Evidence-Based Medicine (EBM).
Proficiency with MS Word, Outlook, and Excel.
Preferred Qualifications
Multiple active state medical licenses.
Prior experience in utilization management, coverage reviews, or medical necessity determinations.
Ability to analyze and interpret clinical and operational data.
Strong communication, presentation, and facilitation skills for both clinical and non-clinical audiences.
Innovative problem-solving aptitude.
Residency in the Pacific Time Zone (preferred due to operational alignment).
Compensation and Benefits
Compensation Range: USD 238,000 to 357,500 (including base salary and bonus).
Compensation varies based on experience, education, productivity, and local labor market conditions.
Comprehensive benefits package, recognition programs, equity stock purchase options, and 401(k) contributions (eligibility requirements apply).
Career development pathways and opportunities for growth within UnitedHealth Group.
Additional Information
Remote employees must follow UnitedHealth Group’s Telecommuter Policy.
Application posting remains open for a minimum of two business days; posting may close early based on applicant volume.
UnitedHealth Group is committed to equitable care, diversity, inclusion, and reducing disparities in healthcare access and outcomes.
This is a drug-free workplace; candidates must pass a drug test before employment.
Equal Opportunity Employer (EOE) in accordance with all federal, state, and local laws.
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