Medical Director, Appeals & Grievances (Remote)

UnitedHealth Group; Cypress (CA); Remoto; USD 249.000 - 373.000; Tempo pieno

Descrizione del lavoro

UnitedHealth Group, through UnitedHealthcare, seeks a Medical Director to lead clinical review and adjudication of appeals and grievances. Remote work within the U.S. is available, with responsibilities spanning case reviews across PPO, HMO, MAPD, and PDP products.

You will shape regulatory responses and provide clinical input for strategic initiatives. The role requires board certification, an active medical license, and 5+ years of clinical practice plus 2+ years in quality management.

Competenze

• 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.
• Proficiency with managed care concepts.
• Strong telephonic communication skills.

Mansioni

• Perform individual case review for appeals and grievances for various health plan and insurance products.
• Respond to Department of Insurance/Department of Managed Healthcare and CMS regulatory requests.
• Communicate with UnitedHealthcare medical directors regarding appeal decisions and benefit interpretations.
• Collaborate with regional and plan medical directors and network management staff on access and quality issues.
• Participate in team meetings focused on communication, feedback, problem solving, and process improvement.
• Provide clinical and strategic input in organizational committees and projects.
• Contribute to the mission of UnitedHealth Group by improving patient care and healthcare system efficiency.

Conoscenze

Telephonic communication

Project management

Data analysis

Presentation skills

Team collaboration

Problem solving

Communication

Formazione

MD or DO with active license

Board Certification (ABMS/AOBMS)

Strumenti

Microsoft Office

Descrizione del lavoro

UnitedHealth Group, through UnitedHealthcare, seeks a Medical Director to lead clinical review and adjudication of appeals and grievances. Remote work within the U.S. is available, with responsibilities spanning case reviews across PPO, HMO, MAPD, and PDP products.

You will shape regulatory responses and provide clinical input for strategic initiatives. The role requires board certification, an active medical license, and 5+ years of clinical practice plus 2+ years in quality management.