About this role
Medical Director, Clinical AI Innovation and Performance
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
- Cle