Appeals M.D. - Radiologist Required - Remote

UnitedHealth Group; Cypress (CA); Remote; USD 249.000 - 373.000; Vollzeit

Benefits dieser Stelle

Remote work flexibility

Competitive compensation

Comprehensive benefits

Equity stock purchase opportunities

401(k)

Professional development

Zusammenfassung

UnitedHealth Group’s UnitedHealthcare division seeks an Appeals Medical Director specializing in Radiology. You will ensure fair, evidence-based review of member appeals and contribute to improved healthcare outcomes across the country, with remote collaboration among physicians, nurses, and clinicians.

This role combines regulatory expertise, independent medical judgment, and leadership across enterprise initiatives, offering growth within the organization and exposure to Medicare and

Qualifikationen

• MD or DO degree with an active, unrestricted medical license.
• Board Certification in an ABMS or AOBMS-recognized specialty.
• Proven solid clinical judgment and ability to apply evidence-based medicine in utilization management and appeals.
• Excellent written and verbal communication skills.

Aufgaben

• Conduct independent clinical reviews of member appeals and grievances involving Medicare and Commercial health plans, including PPO, HMO, ASO, MAPD, and PDP products.
• Evaluate appeals related to adverse coverage determinations for medical services, applying evidence-based medicine, regulatory requirements, and plan benefits.
• Prepare and support responses to inquiries from regulatory agencies, including CMS, Departments of Insurance, and Departments of Managed Health Care.
• Collaborate with fellow Medical Directors regarding appeal determinations, clinical rationale, benefit interpretation, and policy application.
• Participate in departmental meetings focused on quality improvement, process enhancement, clinical consistency, education, and team development.
• Provide clinical expertise and strategic insights on organizational committees, projects, and enterprise initiatives.

Kenntnisse

Clinical judgment

Evidence-based medicine

Written communication

Verbal communication

Ausbildung

MD or DO degree

Active medical license

Board Certification (ABMS/AOBMS)

Jobbeschreibung

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 optimized. Ready to make a difference? Join us in making healthcare work better for everyone through people-led, responsible AI while Caring. Connecting. Growing together.

Make an Impact on Patient Care and Healthcare Quality

At UnitedHealthcare, our mission is to simplify the healthcare experience, create healthier communities, and remove barriers to quality care. As an Appeals Medical Director specializing in Radiology, you will play a critical role in ensuring fair, evidence-based review of member appeals while contributing to improved healthcare outcomes across the country.

Working remotely, you will collaborate with a highly experienced team of physicians, nurses, and clinical professionals dedicated to delivering consistent, high-quality clinical decision making. This role combines independent medical judgment, regulatory expertise, and meaningful collaboration with leaders throughout the organization.

Career Growth and Advancement Opportunities

Joining the Appeals and Grievances team offers more than a rewarding clinical role. It provides a pathway for long-term professional growth within UnitedHealthcare and the broader UnitedHealth Group organization.

Medical Directors in Appeals and Grievances gain broad exposure to:

• Medicare, Commercial, and specialty benefit structures
• Complex medical necessity and coverage determinations
• Regulatory compliance and healthcare policy interpretation
• Enterprise-wide quality, clinical strategy, and operational initiatives
• Cross-functional collaboration with clinical, legal, compliance, policy, and executive leadership teams

This experience provides opportunities for advancement into a broad range of senior physician leadership positions across the organization. As a member of the Appeals and Grievances team, physicians may also participate in high-visibility projects, committees, and strategic initiatives that enhance leadership capabilities, expand organizational influence, and support ongoing professional growth.

Why UnitedHealthcare?

Working here means being part of an organization that is continually evolving to improve the health system while supporting the people who make that mission possible. You'll enjoy:

• A collaborative physician-led culture
• Remote work flexibility
• Competitive compensation and comprehensive benefits
• Employee incentive and recognition programs
• 401(k) and stock purchase opportunities
• Professional development and leadership growth opportunities
• The ability to make a meaningful impact on members' lives every day

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Conduct independent clinical reviews of member appeals and grievances involving Medicare and Commercial health plans, including PPO, HMO, ASO, MAPD, and PDP products
• Evaluate appeals related to adverse coverage determinations for medical services, applying evidence-based medicine, regulatory requirements, and plan benefits
• Prepare and support responses to inquiries from regulatory agencies, including the Centers for Medicare & Medicaid Services (CMS), Departments of Insurance, and Departments of Managed Health Care
• Collaborate with fellow Medical Directors regarding appeal determinations, clinical rationale, benefit interpretation, and policy application
• Participate in departmental meetings focused on quality improvement, process enhancement, clinical consistency, education, and team development
• Provide clinical expertise and strategic insights on organizational committees, projects, and enterprise initiatives 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.

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:

• MD or DO degree with an active, unrestricted medical license
• Board Certification in an ABMS or AOBMS-recognized specialty
• Proven solid clinical judgment and ability to apply evidence-based medicine in a utilization management and appeals environment
• Proven excellent written and verbal communication skills

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $248,500 to $373,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

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 help make the health system work better for everyone. Together, we are shaping the future of healthcare by harnessing technology and innovation to make care simpler to navigate, more affordable and more connected for the people we serve. We are committed to creating an inclusive workplace where everyone feels welcomed, valued, heard and respected, empowering people to bring their authentic selves to work and strengthening our collective impact through diverse talents, backgrounds, experiences and perspectives.

UnitedHealth Group and its affiliated brands are 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 and its affiliated brands are a drug-free workplace. Candidates are required to pass a drug test before beginning employment.