Remote Appeals Medical Director

Tnafp; Cypress, Northern (CA, KY); Hybrid; USD 249,000 - 373,000; Full time

Job summary

UnitedHealth Group is a remote-friendly healthcare organization seeking experienced clinicians to review appeals and grievances, respond to regulatory inquiries, and provide clinical guidance across programs. The role emphasizes communication, data analysis, project management, and collaboration with medical directors and teams.

The position offers remote work within the United States, with a focus on quality management, policy interpretation, and strategic input to committees and initiatives.

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.
• Intermediate or higher level of proficiency with managed care.
• Proven excellent telephonic communication skills; excellent interpersonal communication skills.
• Proven excellent project management skills.
• Proven data analysis and interpretation skills.
• Proven excellent presentation skills for both clinical and non-clinical audiences.

Responsibilities

• 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 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.

Skills

Telephonic communication

Project management

Data analysis

Presentation skills

Teamwork

Education

MD or DO with active license

Tools

Microsoft Word

Microsoft Excel

PowerPoint

Job description

UnitedHealth Group is a remote-friendly healthcare organization seeking experienced clinicians to review appeals and grievances, respond to regulatory inquiries, and provide clinical guidance across programs. The role emphasizes communication, data analysis, project management, and collaboration with medical directors and teams.

The position offers remote work within the United States, with a focus on quality management, policy interpretation, and strategic input to committees and initiatives.