Remote Appeals MD – Clinical Quality & Policy Impact

ISHE; Cypress (CA); Hybrid; USD 249,000 - 373,000; Full time

Benefits offered by this job

Comprehensive benefits package

Stock purchase plan

401k contribution

Incentive programs

Remote work across US

Job summary

UnitedHealth Group, including UnitedHealthcare, is seeking a clinical leader for a remote, full-time role that supports appeals, quality management, and policy interpretation across plans. The position has a substantial impact on patient care and system efficiency.

The ideal candidate is an MD or DO with board certification and 5+ years of clinical practice, plus 2+ years in quality management, with strong data analysis, project management, and communication skills.

Qualifications

• MD or DO with an active, unrestricted license.
• Board Certification 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.
• Strong communication and project management skills.

Responsibilities

• Perform individual case review for appeals and grievances for various health plan products.
• Respond to regulatory tasks from insurance and CMS bodies.
• Coordinate with medical directors on appeals decisions and benefit interpretations.
• Collaborate with network staff on access, availability, and quality issues.
• Participate in team meetings and organizational committees to drive improvements.

Skills

Telephonic communication

Interpersonal communication

Project management

Data analysis

Problem solving

Team player

Education

MD or DO with active license

Board Certification (ABMS/AOBMS)

Job description

UnitedHealth Group, including UnitedHealthcare, is seeking a clinical leader for a remote, full-time role that supports appeals, quality management, and policy interpretation across plans. The position has a substantial impact on patient care and system efficiency.

The ideal candidate is an MD or DO with board certification and 5+ years of clinical practice, plus 2+ years in quality management, with strong data analysis, project management, and communication skills.