Remote Appeals M.D. Pulmonologist – Medical Director

UnitedHealthcare; Cypress (CA); Remote; USD 249,000 - 373,000; Full time

Job summary

UnitedHealth Group is seeking an Appeals Medical Director (Pulmonology - Remote) to oversee ongoing clinical review and adjudication of appeals and grievances across multiple health plans. You will apply clinical criteria, coordinate with medical directors, and help shape program outcomes.

This senior role requires an MD or DO with active license, board certification in an ABMS/AOBMS specialty, 5+ years of clinical practice, and 2+ years in quality management.

Qualifications

• MD or DO with an active, unrestricted license.
• Board Certification in ABMS/AOBMS specialty.
• 5+ years of clinical practice experience.
• 2+ years of Quality Management experience.
• Familiarity with current medical issues and practices.
• Proficiency with managed care processes.
• Excellent telephonic and interpersonal communication skills.
• Strong data analysis and presentation abilities.
• Solid team player and team-building skills.

Responsibilities

• Perform individual case reviews for appeals and grievances across plans (PPO, HMO, MAPD, PDP).
• Handle regulatory responses with DOIs/DMHC and CMS.
• Communicate decision rationales and benefit interpretations with medical directors.
• Coordinate with Regional and Plan medical directors and network staff on access and quality issues.
• Participate in team meetings, process improvement, and staff development.
• Provide clinical and strategic input for organizational committees and projects.

Skills

Telephonic communication

Interpersonal communication

Data analysis & interpretation

Presentation skills

Team player

Managed care familiarity

Education

MD or DO with active license

Board Certified in ABMS/AOBMS specialty

Job description

UnitedHealth Group is seeking an Appeals Medical Director (Pulmonology - Remote) to oversee ongoing clinical review and adjudication of appeals and grievances across multiple health plans. You will apply clinical criteria, coordinate with medical directors, and help shape program outcomes.

This senior role requires an MD or DO with active license, board certification in an ABMS/AOBMS specialty, 5+ years of clinical practice, and 2+ years in quality management.