Appeals Medical Director - Remote

UnitedHealth Group; Cypress (CA); Teletrabalho; USD 249 000 - 373 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Comprehensive benefits

Incentive programs

401k matching

Equity stock purchase

Resumo da oferta

UnitedHealth Group is seeking an Appeals Medical Director to work remotely within the United States. The role focuses on clinical review and adjudication of appeals and grievances across various health plans and products.

You will oversee individual case reviews, regulatory responses, and collaboration with medical directors to ensure accurate benefit interpretations and access to care. A senior clinician with leadership capabilities is needed.

Qualificações

• MD or DO with an active, unrestricted license.
• Board Certified in an ABMS or AOBMS specialty.
• 5+ years clinical practice experience.
• 2+ years of Quality Management experience.
• Intermediate or higher level of proficiency with managed care.
• Basic computer skills including typing, word processing, and spreadsheet apps.
• Proven excellent telephonic communication skills and interpersonal skills.
• Proven data analysis and interpretation skills.
• Strong presentation skills for clinical and non-clinical audiences.
• Creative problem-solving abilities.
• Strong team player with collaborative skills.

Responsabilidades

• Perform ongoing clinical review and adjudication of appeals and grievances.
• Respond to regulatory requirements (DOI/DMHC/CMS) as applicable.
• Communicate with medical directors regarding appeal rationales and benefit interpretations.
• Coordinate with regional and plan medical directors on access, network, and quality issues.
• Participate in team meetings and drive process improvement and staff development.
• Contribute clinical and strategic input in organizational committees and projects.

Conhecimentos

MD/DO license

Board Certified

Clinical review

Data analysis

Presentation skills

Communication skills

Team player

Telephonic communication

Formação académica

MD/DO medical degree

Ferramentas

Microsoft Word

Excel

PowerPoint

Descrição da oferta de emprego

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

Job Description - Appeals Medical Director - Remote (2390745)

Appeals Medical Director - Remote - 2390745

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.

Work at home!

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

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

Primary Responsibilities:

• 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

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 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 clinical practice experience
• 2+ years of Quality Management experience
• Intermediate or higher level of proficiency with managed care
• Basic computer skills, typing, word processing, presentation, and spreadsheet applications skills. Internet researching skills
• 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. Familiarity with current medical issues and practices
• Proven creative problem-solving skills
• Proven solid team player and team building skills

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 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.

Job

Clinical Analysis & Consulting

Primary Location

US-CA-Cypress

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, age, 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.