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

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

Job summary

A leading healthcare organization is seeking a Medical Director specializing in appeals and grievances. This remote role involves case reviews, regulatory compliance, and collaboration with medical directors. Ideal candidates will have extensive clinical experience and strong communication skills. Join a mission-driven team dedicated to improving healthcare outcomes and equity.

Benefits

Comprehensive Benefits

Incentive Programs

Equity Stock Purchase

401k Contributions

Qualifications

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

Responsibilities

• Perform case reviews for appeals and grievances.
• Coordinate with medical directors regarding access and quality issues.
• Provide clinical input for committees and projects.

Skills

Communication

Project Management

Data Analysis

Problem Solving

Teamwork

Education

MD or DO

Board Certified

Tools

Microsoft Office

Job description

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

Be among the first 25 applicants one day ago

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. 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 health outcomes and help heal the health care system. You’ll work within an incredible team culture that fosters clinical and business collaboration, learning, and evolving daily. Your contributions will open doors that are unique to our organization.

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

Primary Responsibilities

• Perform individual case reviews 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 policy adherence.
• Respond 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 regarding access, availability, network, and quality issues.
• Participate actively in team meetings focused on communication, feedback, problem-solving, process improvement, staff training, and sharing program results.
• Provide clinical and strategic input for organizational committees, projects, and task forces.

You will be recognized and rewarded for your performance in an environment that challenges you, provides clear success metrics, and offers development opportunities for other roles.

Required Qualifications

• MD or DO with active, unrestricted license
• Board Certified 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 abilities
• Team player with team-building skills

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

Compensation & Benefits

The salary range is $269,500 to $425,500 annually, based on full-time employment, experience, and performance metrics. Benefits include comprehensive packages, incentive and recognition programs, equity stock purchase, and 401k contributions, among others. 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 volume.

UnitedHealth Group’s mission is to help people live healthier lives and improve the healthcare system for all. We are committed to equity, environmental sustainability, and addressing health disparities, especially among marginalized groups.

We are an Equal Employment Opportunity employer and a drug-free workplace requiring pre-employment drug testing.