Senior Medical Director Clinical Coverage Review - Virtual

Unitedhealth Group Inc. Houston , TX 77020

Posted 1 week ago

Senior Medical Director

Clinical Coverage Review

UnitedHealthcare is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.

When you work with UnitedHealthcare, what you do matters. It's that simpleand it's that challenging.

In providing consumer-oriented health benefit plans to millions of people, our goal is to create higher quality care, lower costs and greater access to health care. Join us and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you contribute to new innovations in a vital and complex system.

A successful applicant for the Senior Medical Director position will have the opportunity to work in a dynamic and growing division of United Healthcare, the Clinical Coverage Review area of the Clinical Services Division. The Senior Medical Director provides senior leadership to and is accountable for the performance and direction of medical directors in this department. The applicant should have experience managing people and processes to meet requirement for regulatory and accreditation compliance, and Human Resources.

The Senior Medical Director for Clinical Coverage Review will have responsibility for managing outpatient and inpatient utilization through pre-and post-service coverage determination and medical necessity review. This work may entail one or more product lines, Commercial, government programs and/or Medicare.

This leadership role requires a strong willingness and ability to work in a matrix environment, excellent analytical capabilities, and the ability to incorporate analytical data into new or existing clinical programs to enhance quality of care, improve outcomes, and manage care and operational costs. These leadership skills are essential to continually improve the pipeline and the results of medical management. This position will involve active work and interfacing with other business units and individuals within United Health Group, and with external business relationships -- both individuals and organizations -- in order to advance our quality and affordability goals. Applicants should have a record of accomplishment and professionalism in managing internal and external business relationships.

This position will play a key role in working with the VP for Clinical Coverage Review and other senior management leaders to assess market conditions, medical cost and trend analyses, and innovative management programs to advance UHC's medical management programs and outcomes. Other duties will be assigned, in order to accommodate the need for agility and flexibility in our fast-changing environment.


Active physician license. REQUIRED

  • Current board certification in ABMS or AOA specialty. REQUIRED

  • 10 years of post-residency direct patient care experience. REQUIRED

  • 5-10 years experience in utilization management and coverage review in a managed care organization. REQUIRED

  • 2 years experience in an administrative role. PREFERRED

  • Excellent interpersonal communication skills.

  • Team player and strong teambuilding skills.

  • Solid PC skills, specifically using MS Word, Outlook, Powerpoint and Excel.

  • Sound knowledge of the managed care industry.

  • Creative problem solving skills.

  • Excellent presentation skills for both clinical and non-clinical audiences.

  • Previous management experience preferred

  • Supervisory skills including clinical mentoring and coaching skills.

  • Excellent performance in current role

  • Proficiency in working in a matrix environment

  • Strategic thinking with proven ability to communicate a vision and drive results

  • Ability to focus on key metrics.

  • Ability to develop relationships with network and community physicians and other providers.

  • Excellent program and project management skills.

  • Familiarity with current medical issues and practices.

  • Strong sense of personal and professional responsibility

  • Excellent presentation skills for both clinical and non-clinical audiences

  • Strong sense of personal and professional responsibility

  • Proficient in utilizing basic Microsoft office tools such as Excel, Word, Power Point, Visio and other tools

  • Experienced in working and documenting in multiple electronic platforms

  • Proficient in analysis and interpretation of clinical data sets

  • Team player with team building skills

  • Proven success in change management

  • Proficiency in working in a matrix environment

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.SM

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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Senior Medical Director Clinical Coverage Review - Virtual

Unitedhealth Group Inc.