UnitedHealth Group

UnitedHealth Group is a healthcare and well-being company that’s dedicated to improving the health outcomes of millions around the world. We are comprised of

Medical Director Utilization Management - Remote

Location

United States

Posted

74 days ago

Salary

$248K - $373K / year

Seniority

Lead

No structured requirement data.

Job Description

Medical Director Utilization Management - Remote

UnitedHealth Group

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. Clinical Advocacy & Support has an unrelenting focus on the customer journey and ensuring we exceed expectations as we deliver clinical coverage and medical claims reviews. Our role is to empower providers and members with the tools and information needed to improve health outcomes, reduce variation in care, deliver seamless experience, and manage health care costs. The Medical Director provides physician support to Enterprise Clinical Services operations, the organization responsible for the initial clinical review of service requests for Enterprise Clinical Services. The Medical Director collaborates with Enterprise Clinical Services leadership and staff to establish, implement, support, and maintain clinical and operational processes related to benefit coverage determinations, quality improvement and cost effectiveness of service for members. The Medical Director's activities primarily focus on the application of clinical knowledge in various utilization management activities with a focus on pre-service benefit and coverage determination or medical necessity (according to the benefit package), and on communication regarding this process with both network and non-network physicians, as well as other Enterprise Clinical Services. The Medical Director collaborates with a multidisciplinary team and is actively involved in the management of medical benefits. The collaboration often involves the member’s primary care provider or specialist physician. It is the primary responsibility of the medical director to ensure that the appropriate and most cost-effective quality medical care is provided to members. You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: - Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, render coverage determinations - Document clinical review findings, actions, and outcomes in accordance with policies, and regulatory and accreditation requirements - Engage with requesting providers as needed in peer-to-peer discussions - Be knowledgeable in interpreting existing benefit language and policies in the process of clinical coverage reviews - Participate in daily clinical rounds as requested - Communicate 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 policy - Communicate and collaborate with other internal partners - Participate in holiday and call coverage rotation You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: - M.D or D.O. - Active board certification in an ABMS or AOBMS specialty - Active unrestricted medical license and ability to obtain additional state medical licenses as needed - 5+ years of clinical practice experience after completing residency training - Proven sound understanding of Evidence Based Medicine (EBM) - Proven solid PC skills, specifically using MS Word, Outlook, and Excel - Ability to participate in rotational holiday and call coverage Preferred Qualifications: - Board certification in either Gastroenterology, Cardiology, Endocrinology, radiation oncology (other specialties will be considered) - Experience in utilization and clinical coverage review - Reside in Nebraska or Texas - Licensure in TX. IN, KS, NE, AZ, WA, FL or a compact license - Proven excellent oral, written, and interpersonal communication skills, facilitation skills - Demonstrated data analysis and interpretation aptitude - Proven innovative problem-solving skills - Demonstrated presentation skills for both clinical and non-clinical audiences *All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy. Compensation for this specialty generally ranges from $248,500 to $373,000. Total cash compensation includes base pay and bonus and is based on several factors including but not limited to local labor markets, education, work experience and may increase over time based on productivity and performance in the role. We comply with all minimum wage laws as applicable. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

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Bristol Myers Squibb logo

Medical Science Liaison, Hematology-Myeloid (Ohio and Michigan)

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Medical Director74 days ago
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Simbec-Orion logo

Medical Director

Simbec-Orion

Simbec-Orion is a responsive and agile full-service CRO, delivering studies from first in man through to Phase III. Our experts leverage wide therapeutic experience and specialist expertise to execute a comprehensive portfolio of trials. We are perfectly structured to provide full-service clinical development solutions for small and mid-size drug developers, headed up by a centralised leadership team. With a focus on tailormade and scalable solutions, we adapt our delivery style, communications and operations to suit the demands of the project, helping clients achieve their clinical and commercial objectives. Because our goal is the same as theirs; to improve patients’ lives.

Medical Director74 days ago
Full TimeRemoteTeam 201-500

Our Mission Our passion for improving patients’ lives motivates us to apply our skills, experience and knowledge to advance medicine. We achieve this through flexible, innovative, high-quality solutions for our clients, delivered with integrity. The Role We are seeking a Medical Director to join our Clinical Development team, providing senior medical oversight for complex clinical studies conducted by Simbec-Orion. You will be responsible for ensuring scientific integrity, patient safety, and regulatory compliance throughout the study lifecycle, while acting as Medical Monitor for assigned trials and delivering expert clinical interpretation and safety leadership. You will work cross-functionally with teams including Clinical Operations, Project Management, Pharmacovigilance, Biometrics, Regulatory, Technical Writing, and Business Development to support high-quality study delivery and consistent medical standards across the organisation. 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Skills Required ESSENTIAL - Medical degree with specialisation in Oncology (or equivalent clinical experience in oncology) - Substantial experience as a Medical Monitor within a clinical research environment, with a focus on oncology studies and patient safety oversight - Extensive experience in clinical trial medical oversight within oncology, including adverse event and serious adverse event management, safety signal evaluation, and regulatory compliance - Experience supporting regulatory inspections and audits, including CAPA development and management - Demonstrable involvement in business development activities, including feasibility assessments, protocol input, proposal development, and bid defence participation within oncology trials - Strong commercial awareness, including understanding of clinical trial budgeting and financial drivers within a CRO environment - Strong written and verbal communication skills, with the ability to translate complex oncology data into clear insights for clients and cross-functional teams - Proficiency in electronic data capture systems, safety databases, and Microsoft Office applications DESIRABLE - GMC registered with a licence to practise (or equivalent international registration) with oncology specialism - Pharmacovigilance experience within oncology, including medical review of ICSRs and periodic safety reports - Experience working within a CRO, biotechnology, or pharmaceutical environment with a focus on oncology drug development - Previous experience leading a medical and/or safety function, including direct line management responsibility About Us Simbec-Orion is a responsive and agile full-service CRO, delivering studies from first in man through to Phase III. Our experts leverage wide therapeutic experience and specialist expertise to execute a comprehensive portfolio of trials. We are perfectly structured to provide full-service clinical development solutions for small and mid-size drug developers, headed up by a centralised leadership team. With a focus on tailormade and scalable solutions, we adapt our delivery style, communications and operations to suit the demands of the project, helping clients achieve their clinical and commercial objectives. Because our goal is the same as theirs; to improve patients’ lives.

United Kingdom
Johnson & Johnson Innovative Medicine logo

Medical Scientific Liaison MSL Immunology – MÁLAGA

Johnson & Johnson Innovative Medicine

At Johnson & Johnson, we believe health is everything. Our strength in healthcare innovation empowers us to build a world where complex diseases are prevented, treated, and cured, where treatments are smarter and less invasive, and solutions are personal. Through our expertise in Innovative Medicine and MedTech, we are uniquely positioned to innovate across the full spectrum of healthcare solutions today to deliver the breakthroughs of tomorrow, and profoundly impact health for humanity.

Medical Director74 days ago
Full TimeRemoteTeam 10,001

At Johnson & Johnson, we believe health is everything. Our strength in healthcare innovation empowers us to build a world where complex diseases are prevented, treated, and cured, where treatments are smarter and less invasive, and solutions are personal. Through our expertise in Innovative Medicine and MedTech, we are uniquely positioned to innovate across the full spectrum of healthcare solutions today to deliver the breakthroughs of tomorrow, and profoundly impact health for humanity. Learn more at jnj.com. As guided by Our Credo, Johnson & Johnson is responsible to our employees who work with us throughout the world. We provide an inclusive work environment where each person is considered as an individual. At Johnson & Johnson, we respect the diversity and dignity of our employees and recognize their merit. Job Function: Medical Affairs Group Job Sub Function: Medical Science Liaison Job Category: Scientific/Technology All Job Posting Locations: Madrid, Spain Job Description: Johnson & Johnson Innovative Medicine is recruiting for a Medical Scientific Liaison MSL IMMUNOLOGY – MÁLAGA Are you ready to make a difference? At Johnson & Johnson, we are committed to addressing and solving some of the most meaningful unmet medical needs through creating an environment where our employees feel valued and can reach their potential. This commitment is embedded in our Credo! About the role This is a field-based Medical Affairs position covering the South of Spain. The Medical Scientific Liaison will act as a scientific partner to healthcare professionals, engaging in peer-to-peer discussions that support appropriate clinical use of Johnson & Johnson medicines in Immunology. About Immunology Our expertise in Innovative Medicine is informed and inspired by patients, whose insights fuel our science-based advancements. Visionaries like you work on teams that save lives by developing the medicines of tomorrow. Our Immunology team leads in the development of transformational medicines for immunological disorders and illnesses. You can influence where medicine is going by restoring health to millions of people living with immune diseases. Learn more at https://www.jnj.com/innovative-medicine The role contributes directly to the local execution of the Medical Affairs strategy by translating scientific evidence into practical clinical dialogue. Through regular scientific exchange, the MSL builds credibility, strengthens relationships with key stakeholders, and supports both short‑term priorities and longer‑term Medical Affairs objectives. The work has a clear focus on improving outcomes for patients living with immune‑mediated diseases. Key responsibilities - The Medical Scientific Liaison develops and delivers an individual activity plan aligned with the country Medical Affairs Plan and relevant Brand Plans. - The role involves maintaining up‑to‑date knowledge of the therapeutic area, treatments, and emerging data in Immunology. - Through planned and on‑request scientific interactions, the MSL communicates balanced and accurate medical information to Leading Specialists and other healthcare partners, in line with approved product information and regulatory standards. This includes participation in medical education initiatives, advisory boards, and scientific meetings at local and regional level. - The role also supports Market Access discussions by communicating objective scientific data to payors and decision‑making bodies, and collaborates closely with internal teams by providing scientific input, training, and support where appropriate. - In addition, the MSL contributes to local medical projects, including studies, registries, investigator‑initiated research, and pre‑approval activities, while capturing insights from the field to inform Medical Affairs planning. All activities are performed in full compliance with pharmacovigilance, healthcare compliance, and company procedures. Qualifications and experience - Candidates should hold a Medical Doctor degree, Pharmacy degree, or a university degree in Natural Sciences or a related scientific discipline. Advanced training or experience in Immunology is preferred. - The role requires solid scientific understanding of the therapeutic area and the ability to analyse and communicate medical data clearly. - Experience in Medical Affairs, an MSL role, clinical research, or a comparable scientific position is expected, along with the credibility to engage in peer‑to‑peer scientific discussions with senior healthcare professionals. - Strong communication skills, the ability to work independently in a field‑based role, and a consistent focus on ethical and compliant conduct are essential. Experience within the pharmaceutical or biotechnology industry, participation in medical education or advisory activities, exposure to payer or Market Access environments, and knowledge of the Spanish healthcare system are advantageous. Additional information - Fluent Spanish and professional English proficiency are required. - The role involves regular regional travel across the South of Spain. - Should hold a valid Driving Licence. - Johnson & Johnson is committed to providing an interview process that is inclusive of our applicants’ needs. If you are an individual with a disability and would like to request an accommodation, external applicants please contact us via https://www.jnj.com/contact-us/careers, internal employees contact AskGS to be directed to your accommodation resource. Required Skills: Preferred Skills: Analytical Reasoning, Analytics Insights, Clinical Data Management, Clinical Trials, Collaborating, Communication, Data Reporting, Detail-Oriented, Digital Culture, Digital Literacy, Execution Focus, Market Research, Medical Affairs, Medical Communications, Medical Compliance, Product Knowledge, Relationship Building, Scientific Research, Technologically Savvy

Spain