[Hiring] National Medical Director, Clinical AI Innovation and Performance @UnitedHealth Group

Role Description

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.

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 (Anthropic, 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. The 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.

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

Requirements

• 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)

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution (all benefits are subject to eligibility requirements)

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 the volume of applicants.