Appeals and Grievances Medical Director - Cardiology Required - Remote

Lensa; Phoenix (AZ); Remote; USD 269,000 - 426,000; Full time

Job summary

A leading health care provider is seeking an Appeals and Grievances Medical Director specializing in Cardiology. This remote position involves reviewing cases, communicating decisions, and contributing to quality management. Ideal candidates will have extensive clinical experience and strong interpersonal skills, working in a collaborative environment to improve health care systems.

Benefits

Health Plans

Incentive Programs

Equity Stock Purchase

401(k)

Qualifications

• 5+ years of clinical practice experience.
• 2+ years of Quality Management experience.

Responsibilities

• Perform case review for appeals and grievances.
• Communicate appeal decision rationales with medical directors.
• Participate in team meetings focused on process improvement.

Skills

Communication

Project Management

Data Analysis

Creative Problem-Solving

Education

MD or DO

Board Certified Cardiologist

Tools

Word Processing

Spreadsheets

Job description

Appeals and Grievances Medical Director - Cardiology Required - Remote

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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 positively. Join us to build the health care system of tomorrow—more responsive, affordable, and equitable. Ready to make a difference? Come, 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 within an incredible team culture—clinical and business collaboration that is learning and evolving daily. Your contributions will open doors that don’t exist elsewhere.

You’ll enjoy the flexibility to work remotely from anywhere within the U.S. while tackling challenging issues.

Primary Responsibilities

1. Perform individual case review for appeals and grievances across various health plan and insurance products, including PPO, ASO, HMO, MAPD, and PDP. Address adverse determinations related to medical services, benefit design, coverage, and clinical criteria of medical policies.
2. Handle Department of Insurance/Department of Managed Healthcare and CMS regulatory responses.
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, availability, network, and quality issues.
5. Participate actively in team meetings focused on communication, feedback, problem-solving, process improvement, staff training, and sharing program results.
6. Provide clinical and strategic input for organizational committees, projects, and task forces.

In return, you'll be rewarded and recognized in a challenging environment that provides clear success pathways and development opportunities.

Required Qualifications

• MD or DO with an active, unrestricted license
• Board Certified Cardiologist in an ABMS or AOBMS specialty
• 5+ years of clinical practice experience
• 2+ years of Quality Management experience
• Intermediate or higher proficiency with managed care
• Basic computer skills: typing, word processing, presentation, spreadsheets, internet research
• Excellent telephonic and interpersonal communication skills
• Strong project management skills
• Data analysis and interpretation skills
• Effective presentation skills for clinical and non-clinical audiences; familiarity with current medical issues
• Creative problem-solving skills
• Solid team player and team-building skills
• Remote employees must adhere to UnitedHealth Group’s Telecommuter Policy

The salary range is $269,500 to $425,500 annually, based on full-time employment, experience, and metrics achievement. Compensation includes benefits such as health plans, incentive programs, equity stock purchase, and 401(k). Benefits are subject to eligibility.

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

Our mission is to help people live healthier lives and improve the health system. We are committed to equity, environmental stewardship, and addressing health disparities, especially for marginalized groups.

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

Additional Information

• Seniority level: Mid-Senior level
• Employment type: Full-time
• Job function: Health Care Provider