Medical Director – Pharmacy (Remote)
Location: Remote (US-based)
Company: Optum (UnitedHealth Group)
Compensation: $238,000 – $357,500 per year (base + performance bonus)
Work Mode: Remote (Telecommuter Policy applies)
Job Summary
Optum is seeking an experienced Medical Director – Pharmacy to provide clinical leadership within the Focused Pharmacy Review Team and Clinical Coverage Review (CCR) operations. This role involves applying evidence-based medicine (EBM), reviewing outpatient pharmacy requests, guiding utilization management, and collaborating with cross-functional teams to ensure accurate and timely benefit determinations. Ideal for physicians with a background in internal medicine, family practice, or emergency medicine who have a passion for clinical strategy, pharmacy benefit management, and healthcare innovation.
Key Responsibilities
Review and approve or deny pre-service outpatient medication requests using clinical expertise and medical records.
Conduct coverage determinations based on plan documents, UHC medical policy, and national guidelines.
Provide clinical guidance to CCR nurses, pharmacists, and non-clinical teams.
Engage in peer-to-peer calls with network and non-network physicians for coverage decisions.
Document review findings in compliance with accreditation and regulatory requirements.
Participate in national committees, task forces, and process improvement initiatives.
Lead and mentor CCR staff, ensuring high performance and alignment with operational goals.
Participate in rotational weekend and holiday call coverage.
Maintain and obtain additional state medical licenses as needed.
Required Skills & Qualifications
Active, unrestricted physician license (US).
Board certification in Internal Medicine, Family Practice, or Emergency Medicine.
5+ years of post-residency clinical practice experience.
Strong understanding of evidence-based medicine (EBM).
Hands-on experience with electronic clinical systems.
Proficiency in MS Word, Outlook, Excel.
Preferred Qualifications
Board certification in Gastroenterology, Rheumatology, or Hematology-Oncology.
Experience in utilization review or managed care.
Clinical practice experience within the last 2 years.
Knowledge of Medicare and Medicaid regulations.
Data analysis and interpretation skills.
Residency in PST or MST time zones is preferred.
Perks & Benefits
Salary range: $238,000 – $357,500 per year (total cash compensation at target).
Comprehensive medical, dental, and vision coverage.
401(k) with company contribution & equity stock purchase plan.
Incentive and recognition programs.
Professional development and career growth within UnitedHealth Group.
Remote flexibility with telecommuting support.
Company Description
Optum, part of UnitedHealth Group, is a global leader in healthcare services, focused on improving health outcomes through advanced technology, data-driven insights, and integrated pharmacy benefit management. With millions of lives impacted, Optum drives value-based care, innovation, and equitable healthcare delivery worldwide.
Work Mode
Remote – Available across the U.S. (Telecommuter Policy applies).
Apply Now
Lead pharmacy coverage strategy and utilization management with a global healthcare leader. Apply today to join Optum and make a measurable impact on patient outcomes.
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