Appeals and Grievances Medical Director - Cardiology Required - Remote

Lensa; Cypress (CA); Remote; USD 269,000 - 426,000; Full time

Job summary

A leading healthcare organization is seeking an Appeals and Grievances Medical Director specializing in Cardiology. This remote role involves reviewing cases, responding to regulatory inquiries, and providing strategic input. Ideal candidates will have an MD or DO, board certification, and extensive clinical experience. Join us to impact the healthcare experience positively.

Benefits

Comprehensive benefits package

Incentives and stock options

401(k) plan

Qualifications

• Minimum 5 years clinical practice experience.
• At least 2 years in Quality Management.
• Proficiency in managed care concepts.

Responsibilities

• Perform individual case reviews for appeals and grievances.
• Respond to regulatory inquiries.
• Communicate appeal decision rationales.

Skills

Telephonic communication

Interpersonal communication

Project management

Data analysis

Creative problem-solving

Team-building

Education

MD or DO with active, unrestricted license

Board Certified Cardiologist

Tools

Basic computer skills

Job description

Appeals and Grievances Medical Director - Cardiology Required - Remote

Be among the first 25 applicants

Lensa is the leading career site for job seekers at every stage of their career. Our client, UnitedHealth Group, is seeking professionals. Apply via Lensa today!

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities, and removing barriers to quality care. The work you do impacts the lives of millions. Join us to build a more responsive, affordable, and equitable health care system. Ready to make a difference? Come join us in Caring. Connecting. Growing together.

What makes your clinical career greater with UnitedHealth Group? You can improve the health of others, help heal the health care system, work within an evolving team culture, and open unique career opportunities. Enjoy the flexibility to work remotely * from anywhere in the U.S. as you take on meaningful challenges.

Primary Responsibilities

1. Perform individual case reviews for appeals and grievances related to various health plan and insurance products, including PPO, HMO, MAPD, and PDP, focusing on adverse determinations for medical services based on benefit design, coverage, and clinical policy application.
2. Respond to Department of Insurance, Department of Managed Healthcare, and CMS regulatory inquiries.
3. Communicate appeal decision rationales and benefit interpretations with UnitedHealthcare medical directors.
4. Coordinate with regional and plan medical directors and network management regarding access, network, and quality issues.
5. Participate actively in team meetings focused on communication, feedback, process improvement, staff training, and program results sharing.
6. Provide clinical and strategic input for organizational committees, projects, and task forces.

We offer a challenging environment with clear success metrics and development opportunities for future roles.

Required Qualifications

• MD or DO with active, unrestricted license
• Board Certified Cardiologist (ABMS or AOBMS)
• Minimum 5 years clinical practice experience
• At least 2 years in Quality Management
• Proficiency in managed care concepts
• Basic computer skills: typing, word processing, presentation, spreadsheets, internet research
• Excellent telephonic and interpersonal communication skills
• Strong project management capabilities
• Data analysis and interpretation skills
• Effective presentation skills for clinical and non-clinical audiences
• Creative problem-solving skills
• Team player with team-building skills

Remote employees must adhere to UnitedHealth Group’s Telecommuter Policy.

The salary range is $269,500 to $425,500 annually, depending on experience and achievement. Benefits include comprehensive packages, incentives, stock options, and 401(k).

Application Deadline: Posted for at least 2 business days or until a sufficient candidate pool is reached. Early removal possible due to volume.

UnitedHealth Group is committed to diversity, equity, and inclusion, and is an Equal Opportunity Employer. We comply with all applicable laws and conduct drug testing prior to employment.