Appeals Medical Director - Radiology Required - Remote

Taleo; Cypress (CA); Remote; USD 248,000 - 373,000; Full time

Benefits offered by this job

Remote work

Job summary

UnitedHealth Group in the United States is seeking an Appeals Medical Director in Radiology for a remote role. You will oversee clinical review and adjudication of appeals and grievances across plans, contributing to quality care and regulatory compliance.

The role requires MD or DO, board certification, 5+ years of clinical practice, and strong communication and data analysis skills. You will work with medical directors and network staff to improve access, quality and policy adherence.

Qualifications

• MD or DO with an active, unrestricted license.
• Board certification by ABMS or AOBMS.
• 5+ years of clinical practice experience.
• 2+ years of quality management experience.
• Familiarity with current medical issues and managed care.
• Proven telephonic and interpersonal communication skills.
• Proven data analysis and interpretation skills.
• Proven presentation skills for clinical and non-clinical audiences.
• Proven creative problem solving and teamwork.
• Proficient with basic computer skills and internet research.

Responsibilities

• Perform individual case review for appeals and grievances for various plans.
• Respond to regulatory reviews from DO/DMHC and CMS.
• Communicate decision rationales and benefit interpretations with medical directors.
• Coordinate with regional and plan medical directors on access and network quality.
• Participate in team meetings focused on communication, feedback, problem solving and process improvement.
• Provide clinical and strategic input in committees, projects and task forces.

Skills

MD/DO license

Board Certification

Clinical experience

Quality management

Telephonic communication

Data analysis

Presentation skills

Problem solving

Computer skills

Team player

Job description

Improve the lives of others while Caring. Connecting. Growing together.

Job Description - Appeals Medical Director - Radiology Required - Remote (2383588)

Appeals Medical Director - Radiology Required - Remote - 2383588

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 to start Caring. Connecting. Growing together

Work at home!

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 in 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. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.

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:

• 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
• Perform Department of Insurance/Department of Managed Healthcare, and CMS regulatory responses
• Communicate with UnitedHealthcare medical directors regarding appeals decision rationales, and benefit interpretations
• Communicate with UnitedHealthcare Regional and Plan medical directors and network management staff regarding access, availability, network, and quality issues
• Actively participate in team meetings focused on communication, feedback, problem solving, process improvement, staff training and evaluation, and the sharing of program results
• 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:

• MD or DO with an active, unrestricted license
• Board Certified in an ABMS or AOBMS specialty
• 5+ years of clinical practice experience
• 2+ years of Quality Management experience
• Familiarity with current medical issues and practices
• Intermediate or higher level of proficiency with managed care
• Proven excellent telephonic communication skills; excellent interpersonal communication skills
• Proven data analysis and interpretation skills
• Proven excellent presentation skills for both clinical and non-clinical audiences
• Proven creative problem‑solving skills
• Proven basic computer skills, typing, word processing presentation, and spreadsheet applications skills. Internet researching skills
• Proven solid team player and team building 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 - $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 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.

Job

Job

Clinical Analysis & Consulting

Primary Location

Primary Location

US-CA-Cypress

Other Locations

Other Locations

US-IL-Chicago, US-AZ-Phoenix, US-TX-Houston, US-MA-Boston, US-FL-Tampa

UnitedHealth Group is committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities. If you need special assistance or accommodation for any part of the application process, please call 1-866-566-8715 to be connected to Recruitment Services. Recruitment Services hours of operation are 7 a.m. to 7 p.m. CT, Monday through Friday.

UnitedHealth Group is a registered service mark of UnitedHealth Group, Inc. The UnitedHealth Group name with the dimensional logo, as well as the dimensional logo alone, are both service marks for the UnitedHealth Group, Inc.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

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