National Medical Director, Clinical AI Innovation and Performance - Remote

Job description

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together

UnitedHealthcare is leveraging AI, real-time data and a modern platform to modernize clinical programs - starting with Utilization Management. The Medical Director, Clinical AI Innovation and Performance is a senior physician leader responsible for the clinical AI model training, testing and surveillance. Work will initially focus on utilization management (UM) clinical criteria-leveraging InterQual, UHC custom specialty content and other evidence-based criteria. The MD will establish efficient and consistent annotation, training and testing models to ensure medical policies are accurately interpreted, evidence based, consistently applied, and operationally effective,

This role serves as the clinical authority for guideline interpretation, clarification, and enhancement, ensuring that approved medical policy and supporting evidence are translated into UM clinical criteria that enable appropriate coverage decisions, support safe and effective care, and scale across enterprise operations. The initial focus will be on Prior Authorization and will expand to include Inpatient Level of Care. Clinical Care Management and Comprehensive Medication Management.

The clinical annotation, training and testing team will report to this physician. The MD will be the primary clinical relationship to Foundation model clinical teams (Antrhopic, OpenAI, Gemini). The CMO will work closely with the CMO Medical Policy, the CMO Value Creation, the CMO of Medical Management and the MD, Data Science. MD will also be a key member of the UCS clinical and AI leadership team, collaborating on clinical program design, data models, AI use and modernization.

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

InterQual Expertise, Interpretation & Guideline Enhancement Maintain deep expertise in InterQual criteria, evidence framework, and decision logic

Ensure consistent, accurate interpretation of InterQual criteria across: Services, settings, and levels of care

Reviewer types and UM workflows

Lead guideline clarification, customization, and enhancement where needed to: Improve clinical clarity and consistency

Address operational ambiguity or recurring edge cases

Enhance the ability to ensure care is safe and effective

Develop and approve evidence based enhancements or supplemental criteria that add clinical clarity while remaining aligned with approved medical policy

Work closely with leaders in Medical Policy and evidence teams to ensure: Alignment with policy intent

Clear translation of policy into UM ready clinical criteria

Evidence Based UM Clinical Criteria Ensure UM clinical criteria are: Explicitly grounded in clinical evidence and accepted guidelines

Structured for consistent application at scale

Clear and actionable for nurses, physician reviewers, and AI enabled workflows

Apply senior clinical judgment in situations where: Evidence is evolving or limited

Criteria require interpretation to ensure appropriate coverage decisions

Promote consistent clinical standards across UM operations while recognizing the need for appropriate clinical flexibility

UM Operations & Coverage Interpretation Leadership Ensure UM criteria function effectively in production environments: Supporting timely and appropriate coverage decisions

Reducing unwarranted variation across reviewers

Aligning clinical interpretation with operational reality

Partner closely with UM Operations and Nursing leadership to: Identify areas of confusion or friction in criteria application

Address recurring themes from operational feedback

Improve reviewer confidence and consistency

Clinical Annotation & LLM Training for UM Lead teams responsible for clinical annotation and analysis supporting LLM based UM decision support

Oversee the clinical review process that ensures: Accurate interpretation of UM criteria by LLMs

Reliable assessment of whether clinical documentation meets criteria

Provide clinical oversight and judgment where: Annotator disagreement exists

Criteria vary in complexity or trainability

Additional training data or clarification is required

Ensure annotation and training processes support clinically accurate, reliable model performance

AI Lifecycle Participation & Governance (UCS Led) Serve as a senior physician leader within UCS led AI governance, under the authority of the UHC CMO

Participate in reviews across AI lifecycle phases: Training and validation

Shadow mode

AI assist (clinical in the loop)

Production deployment

Contribute clinical judgment to evaluations of: Precision and recall

Clinical accuracy and safety

Readiness for use in automated approvals

Identify areas where additional training, refinement, or safeguards are required

Cross Functional Clinical Leadership & Continuous Improvement Directly manage: Clinical annotators

Clinical or UM analysts supporting AI enablement and criteria oversight

Work closely with: Medical Policy leadership

CARES team conducting rigorous UM case review and quality evaluation

UM Operations and Appeals

Product, ECS, and AI / data science teams

Ensure insights from production, appeals, audits, and quality reviews inform: Guideline clarification and enhancement

Reviewer guidance

Cross Functional Clinical Leadership & Continuous Improvement

You will 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:

MD or DO with active/unrestricted U.S. Medical Licensure

Board certification in an ABMS/AOBMS Clinical specialty

Significant experience in:

Utilization management

Coverage interpretation using UM clinical criteria

Clinical operations in large, complex organizations

Demonstrated experience working with InterQual clinical criteria

Experience with UM physicians and nursing teams at scale

Proven ability to lead through influence across clinical, operational, and technical teams

Preferred Qualifications:

Experience across Commercial and/or Government program UM

Experience working with MCG guidelines

Proven direct responsibility for UM operations leadership

Proven exposure to AI enabled clinical workflows or advanced decision support (technical expertise not required)

Leadership Profile (Senior Leadership Team Level)

Recognized clinical authority with strong peer credibility

Demonstrated judgment in complex or ambiguous clinical scenarios

Able to operate at enterprise scale while maintaining clinical rigor

Comfortable providing clinical guidance on AI use in high impact workflows

Trusted advisor to executive leadership across UCS and UHC

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. 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. The salary for this role will range from $386,500 - $579,500 annually based on full-time employment. We comply with all minimum wage laws as applicable.

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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Worksite address

minnetonka, MN, 55345, US

Who can apply

Review the original listing for work authorization, qualifications and employer requirements.