Remote Appeals Medical Director - Equity & 401k

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

Benefits offered by this job

Comprehensive benefits package

Incentive and recognition programs

Equity stock purchase

401k contribution

Job summary

UnitedHealthcare is seeking an Appeals and Grievances Medical Director to lead clinical review and adjudication of appeals and grievances across multiple health plans. The role requires an MD/DO with a current license and board certification, backed by at least five years of clinical practice and two years in Quality Management.

The position is remote with collaboration across medical directors, regulatory bodies, and network management.

Qualifications

• 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.
• Proven telephonic and interpersonal communication skills.
• Proven project management and data analysis skills.
• Proven presentation skills for clinical and non-clinical audiences.
• Proven solid team player and problem-solving skills.

Responsibilities

• Perform individual case review for appeals and grievances across health plans and products.
• Handle regulatory responses (DOI/DMHC/CMS).
• Communicate with medical directors on rationales and benefit interpretations.
• Coordinate with regional and plan medical directors and network staff on access, network 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.

Skills

MD/DO license

Board Certified

Quality Management

Managed care proficiency

Telephonic communication

Project management

Data analysis

Presentation skills

Team player

Adaptability

Education

MD/DO degree

Tools

MS Office

Internet research

Job description

UnitedHealthcare is seeking an Appeals and Grievances Medical Director to lead clinical review and adjudication of appeals and grievances across multiple health plans. The role requires an MD/DO with a current license and board certification, backed by at least five years of clinical practice and two years in Quality Management.

The position is remote with collaboration across medical directors, regulatory bodies, and network management.