[Remote] UM Medical Director - Pediatrics and Internal Medicine - Remote

Note: The job is a remote job and is open to candidates in USA. Optum is a global organization focused on improving health outcomes through technology and care delivery. The Medical Director for Pediatrics and Internal Medicine will support clinical operations, conducting coverage reviews and collaborating with healthcare providers to ensure cost-effective quality medical care. This role involves engaging in clinical rounds, communicating with providers, and participating in coverage determinations to enhance member care.ResponsibilitiesConduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, render coverage determinationsDocument clinical review findings, actions, and outcomes in accordance with policies, and regulatory and accreditation requirementsEngage with requesting providers as needed in peer-to-peer discussionsBe knowledgeable in interpreting existing benefit language and policies in the process of clinical coverage reviewsParticipate in daily clinical rounds as requestedCommunicate and collaborate with network and non-network providers in pursuit of accurate and timely benefit determinations for plan participants while educating providers on benefit plans and medical policyCommunicate and collaborate with other internal partnersParticipate in holiday and call coverage rotationSkillsM.D or D.OBoard certification in Internal Medicine and Pediatrics through the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA)Active unrestricted medical license and ability to obtain additional state medical licenses as needed5+ years of clinical practice experience after completing residency trainingProven sound understanding of Evidence Based Medicine (EBM)Proven solid PC skills, specifically using MS Word, Outlook, and ExcelAbility to participate in rotational holiday and call coverageExperience in utilization and clinical coverage reviewReside in Nebraska or TexasLicensure in TX. IN, KS, NE, AZ, WA, FL or a compact licenseProven excellent oral, written, and interpersonal communication skills, facilitation skillsDemonstrated data analysis and interpretation aptitudeProven innovative problem-solving skillsDemonstrated presentation skills for both clinical and non-clinical audiencesAll employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter PolicyBenefitsA comprehensive benefits packageIncentive and recognition programsEquity stock purchase401k contribution (all benefits are subject to eligibility requirements)Flexibility to work remotely rom anywhere within the U.S.Company OverviewWe’re evolving health care so everyone can have the opportunity to live their healthiest life. It was founded in 1985, and is headquartered in Eden Prairie, Minnesota, USA, with a workforce of 10001+ employees. Its website is https://frontiertherapies.optum.com.Company H1B SponsorshipOptum has a track record of offering H1B sponsorships, with 73 in 2026, 648 in 2025, 559 in 2024, 620 in 2023, 851 in 2022, 593 in 2021, 438 in 2020. Please note that this does not guarantee sponsorship for this specific role.