Clinical Review Medical Director - Vascular Surgery - Remote - 2323818 - Phoenix - UnitedHealth Group

    UnitedHealth Group
    UnitedHealth Group Phoenix

    3 days ago

    Healthcare
    Description

    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.

    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 outcomes in accordance with policies regulatory accreditation requirementsEngage requesting providers peer-to-peer discussionsBe knowledgeable interpreting existing benefit language policies process of clinical coverage reviewsParticipate daily clinical rounds requestedCommunicate collaborate network non-network providers pursuit accurate timely benefit determinations plan participants educating providers benefit plans medical policyCommunicate collaborate internal partnersCall coverage rotation

      You'll be rewarded recognized performance environment challenge you clear direction succeed role provide development roles interested


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