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 seeks a Board Certified Cardiologist to perform case reviews for appeals and grievances, ensuring high-quality care through collaboration with medical directors and insurance departments. Candidates should have extensive clinical experience and demonstrate exceptional communication and project management skills. The position allows for remote work within the U.S. and includes a competitive salary and comprehensive benefits.

Benefits

Comprehensive benefits packages

Incentive and recognition programs

Equity stock purchase options

401(k) contributions

Qualifications

• 5+ years of clinical practice experience is essential.
• 2+ years of experience in Quality Management is required.
• Proficiency in basic computer skills, including word processing and spreadsheets.

Responsibilities

• Review appeals and grievances for various health plan products.
• Communicate with medical directors regarding appeals decisions.
• Participate in team meetings for process improvement and feedback.

Skills

Telephonic communication

Interpersonal communication

Project management

Data analysis

Creative problem-solving

Team collaboration

Education

MD or DO with active license

Board Certified Cardiologist

Job description

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 here impacts the lives of millions of people for the better. Join us to build a more responsive, affordable, and equitable health care system. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

What makes your clinical career greater with UnitedHealth Group? You can improve the health of others and help heal the health care system. You’ll work with an incredible team culture—clinical and business collaboration that is learning and evolving every day. Your contributions will open doors that simply do not exist in any other organization, anywhere.

You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on challenging opportunities.

Primary Responsibilities

1. Perform individual case review for appeals and grievances for various health plan and insurance products, including PPO, ASO, HMO, MAPD, and PDP, related to adverse determinations for medical services.
2. Handle Department of Insurance/Department of Managed Healthcare, and CMS regulatory responses.
3. Communicate with UnitedHealthcare medical directors regarding appeals decisions and benefit interpretations.
4. Coordinate with regional and plan medical directors and network management staff on access, availability, network, and quality issues.
5. Participate in team meetings focused on communication, feedback, problem solving, process improvement, staff training, and sharing program results.
6. Provide clinical and strategic input in organizational committees, projects, and task forces.

You’ll be rewarded and recognized for your performance in an environment that challenges you and provides clear development pathways for your career growth.

Required Qualifications

1. MD or DO with an active, unrestricted license.
2. Board Certified Cardiologist in an ABMS or AOBMS specialty.
3. 5+ years of clinical practice experience.
4. 2+ years of Quality Management experience.
5. Proficiency with managed care at an intermediate or higher level.
6. Basic computer skills including typing, word processing, presentation, and spreadsheet applications; internet research skills.
7. Excellent telephonic and interpersonal communication skills.
8. Strong project management skills.
9. Data analysis and interpretation skills.
10. Excellent presentation skills for clinical and non-clinical audiences; familiarity with current medical issues and practices.
11. Creative problem-solving skills.
12. Solid team player with team-building skills.
13. Remote employees must adhere to UnitedHealth Group’s Telecommuter Policy.

The salary range for this role is $269,500 to $425,500 annually, based on full-time employment and experience. Benefits include comprehensive packages, incentive and recognition programs, equity stock purchase, and 401k contributions. Benefits are subject to eligibility requirements.

Application Deadline: The posting will remain for at least 2 business days or until a sufficient candidate pool is achieved. Early removal may occur due to volume of applications.

Our mission at UnitedHealth Group is to help people live healthier lives and improve the health system for everyone. We are committed to addressing health disparities and promoting equitable care, reflecting our enterprise priorities.

UnitedHealth Group is an Equal Employment Opportunity employer and a drug-free workplace. Candidates must pass a drug test before employment begins.