Appeals and Grievances Medical Director - Oncologist Required - Virtual - Remote

UnitedHealth Group; Chicago (IL); Remote; USD 200,000 - 250,000; Full time

Job summary

A leading health care organization is seeking a Medical Director for Appeals and Grievances. This role involves clinical review and adjudication of cases, requiring an MD or DO with significant clinical and quality management experience. The position offers remote work flexibility and a collaborative team environment focused on improving health care outcomes.

Benefits

Comprehensive benefits package

Incentive and recognition programs

Equity stock purchase

Qualifications

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

Responsibilities

• Perform individual case review for appeals and grievances.
• Communicate with medical directors regarding appeals decisions.

Skills

Communication

Project Management

Data Analysis

Problem Solving

Team Building

Education

MD or DO

Board Certified

Tools

Microsoft Office

Job description

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 equitable. 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 can work with an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself 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 some tough challenges.

Primary Responsibilities :

The Appeals and Grievances Medical Director is responsible for ongoing clinical review and adjudication of appeals and grievances cases for UnitedHealthcare associated companies. Performance accountabilities include :

1. Perform individual case review for appeals and grievances for various health plan and insurance products, which may include PPO, ASO, HMO, MAPD, and PDP. The appeals are in response to adverse determinations for medical services related to benefit design and coverage and the application of clinical criteria of medical policies
2. Perform Department of Insurance / Department of Managed Healthcare, and CMS regulatory responses
3. Communicate with UnitedHealthcare medical directors regarding appeals decision rationales, and benefit interpretations
4. Communicate with UnitedHealthcare Regional and Plan medical directors and network management staff regarding access, availability, network, and quality issues
5. Actively participate in team meetings focused on communication, feedback, problem solving, process improvement, staff training and evaluation, and the sharing of program results
6. Provide clinical and strategic input when participating in organizational committees, projects, and task forces

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications :

1. MD or DO with an active, unrestricted license
2. Board Certified in an ABMS or AOBMS specialty
3. 5+ years clinical practice experience
4. 2+ years Quality Management experience
5. Intermediate or higher level of proficiency with managed care
6. Basic computer skills, typing, word processing, presentation, and spreadsheet applications skills. Internet researching skills
7. Proven excellent telephonic communication skills; excellent interpersonal communication skills
8. Proven excellent project management skills
9. Proven data analysis and interpretation skills
10. Proven excellent presentation skills for both clinical and non-clinical audiences. Familiarity with current medical issues and practices
11. Proven creative problem-solving skills
12. Proven solid team player and team building skills
13. All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

The salary range for this role is $, to $, annually based on full-time employment. Salary Range is defined as total cash compensation at target. The actual range and pay mix of base and bonus is variable based upon experience and metric achievement. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

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 volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.