Medical Director – Utilization Management (Remote, USA)
Requisition Number: 2312337
Category: Medical and Clinical Operations
Primary Location: Austin, Texas, United States
Work Model: Remote (within the U.S.)
Overview
Optum, a leading global healthcare organization, is seeking a Medical Director – Utilization Management to support its Enterprise Clinical Services division. This role plays a critical part in improving health outcomes by guiding clinical coverage decisions, supporting operational processes, and ensuring high-quality, cost-effective medical care for members across the United States.
The position offers the flexibility of working remotely and the opportunity to contribute to a mission-driven organization that integrates technology, clinical insight, and patient-centered care.
Key Responsibilities
Conduct clinical coverage reviews based on member benefit plans and internal/external coverage policies.
Provide final coverage determinations and document findings in accordance with regulatory and accreditation standards.
Participate in peer-to-peer discussions with requesting providers when needed.
Interpret benefit language and apply evidence-based medical standards during clinical reviews.
Attend clinical rounds and contribute to case discussions as required.
Collaborate with internal teams and external providers to ensure timely and accurate benefit determinations.
Educate providers on medical policies and benefit structures.
Participate in rotational holiday and call coverage assignments.
Required Qualifications
MD or DO degree.
Active, unrestricted U.S. medical license with the ability to obtain additional state licenses as required.
Active board certification from ABMS or AOBMS.
Minimum 5 years of post-residency clinical practice experience.
Strong understanding of Evidence-Based Medicine (EBM).
Proficiency in MS Word, Outlook, and Excel.
Ability to work rotational holiday and on-call schedules.
Preferred Qualifications
Board certification in Gastroenterology, Cardiology, Endocrinology, Radiation Oncology, or related specialties.
Previous experience in utilization management or clinical coverage review.
Residence in Nebraska or Texas (preferred but not required).
Strong communication, analytical, and interpersonal skills.
Ability to interpret clinical data and present findings to both clinical and non-clinical audiences.
Demonstrated problem-solving and facilitation skills.
Compensation and Benefits
Annual compensation range: USD 238,000 – 357,500 (includes base salary and performance-based bonuses).
Compensation may vary based on location, experience, and performance.
Comprehensive benefits package, including health coverage, recognition programs, stock purchase options, and 401(k) contributions (eligibility criteria apply).
Work Environment
This role is fully remote within the United States and adheres to UnitedHealth Group’s Telecommuter Policy.
Application review continues until the position receives a sufficient candidate pool.
About Optum and UnitedHealth Group
UnitedHealth Group is committed to advancing equitable healthcare by improving access, reducing disparities, and supporting healthier communities. The organization provides equal employment opportunities and complies with all applicable federal, state, and local regulations.
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