Remote Appeals MD – Radiation Oncology Expert

Colorado Psychiatric; Cypress (CA); Hybride; USD 249 000 - 373 000; Plein temps

Avantages offerts par ce poste

Comprehensive benefits package

Equity stock purchase plan

401k contribution

Résumé du poste

UnitedHealth Group is seeking a physician leader to drive appeals and grievances processing for multiple health plans. The role focuses on regulatory responses, clinical rationale, and collaborative decision-making with medical directors and network teams.

This remote position emphasizes telephonic communication, data interpretation, and strategic input in committees and initiatives. A robust clinical background and management experience are essential to succeed.

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.
• Proven excellent telephonic communication skills.
• Proven excellent project management 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.
• Proven solid team player and team building skills.

Responsabilités

• Perform individual case review for appeals and grievances for various health plan and insurance products.
• 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 Regional and Plan medical directors and network management staff regarding access, availability, network, and quality issues.
• 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.

Connaissances

Telephonic communication

Project management

Data analysis

Presentations

Teamwork

Computer literacy

Formation

MD or DO with active license

ABMS/AOBMS board certification

Outils

Microsoft Office

Description du poste

UnitedHealth Group is seeking a physician leader to drive appeals and grievances processing for multiple health plans. The role focuses on regulatory responses, clinical rationale, and collaborative decision-making with medical directors and network teams.

This remote position emphasizes telephonic communication, data interpretation, and strategic input in committees and initiatives. A robust clinical background and management experience are essential to succeed.