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

Lensa; Houston (TX); Remote; USD 269,000 - 426,000; Full time

Job summary

A leading healthcare organization is seeking an Appeals and Grievances Medical Director - Oncologist. This remote role involves reviewing cases, handling regulatory inquiries, and providing clinical input. Join a team dedicated to improving healthcare outcomes and enjoy flexible work arrangements.

Benefits

Comprehensive benefits package

Incentive programs

Equity stock purchase

401k contributions

Qualifications

• At least 5 years of clinical practice experience.
• Minimum 2 years of Quality Management experience.

Responsibilities

• Perform individual case reviews for appeals and grievances.
• Handle regulatory inquiries and communicate decisions.

Skills

Communication

Project Management

Data Analysis

Problem Solving

Education

MD or DO

Board Certified

Tools

Microsoft Office

Job description

Appeals and Grievances Medical Director - Oncologist Required - Virtual - 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 help build a more responsive, affordable, and equitable healthcare 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 healthcare system. You’ll work with an incredible team culture that fosters clinical and business collaboration, learning, and evolving every day. Contributing here opens doors that are unmatched elsewhere.

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you tackle challenging issues.

Primary Responsibilities

• Perform individual case reviews for appeals and grievances across various health plan and insurance products, including PPO, ASO, HMO, MAPD, and PDP, addressing adverse determinations related to medical services, benefit design, and clinical criteria.
• Handle responses to Department of Insurance/Department of Managed Healthcare and CMS regulatory inquiries.
• Communicate appeal decision rationales and benefit interpretations with UnitedHealthcare medical directors.
• Coordinate with regional and plan medical directors and network management staff regarding access, availability, network, and quality issues.
• Participate actively in team meetings focused on communication, feedback, process improvement, staff training, and program results sharing.
• Provide clinical and strategic input in organizational committees, projects, and task forces.

You’ll be rewarded and recognized for your performance in a challenging environment that provides clear success pathways and development opportunities for other roles.

Required Qualifications

• MD or DO with active, unrestricted license
• Board Certified in an ABMS or AOBMS specialty
• At least 5 years of clinical practice experience
• Minimum 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 abilities
• Data analysis and interpretation skills
• Effective presentation skills for clinical and non-clinical audiences; familiarity with current medical issues
• 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 based on full-time employment, experience, and metrics. Benefits include comprehensive packages, incentive programs, equity stock purchase, and 401k contributions. Benefits are subject to eligibility.

Application Deadline: This posting remains for at least 2 business days or until enough candidates apply. It may close early due to volume.

At UnitedHealth Group, our mission is to help people live healthier lives and improve the healthcare system. We are committed to equity, environmental sustainability, and addressing health disparities, ensuring everyone has the opportunity for their healthiest life.

UnitedHealth Group is an Equal Employment Opportunity employer. All qualified applicants will receive consideration regardless of race, gender, age, religion, sexual orientation, gender identity, disability, or veteran status. We are a drug-free workplace requiring a pre-employment drug test.

Additional Details

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