Remote Appeals Medical Director (MD/DO)

UnitedHealth Group; United States; Remote; USD 249,000 - 373,000; Full time

Job summary

UnitedHealth Group’s UnitedHealthcare arm seeks a Medical Director to lead appeals and grievances clinical review and adjudication across plans. This remote role allows work from anywhere in the U.S. while impacting patient care and policy interpretation.

You will review cases, respond to regulatory bodies, collaborate with medical directors and network staff, and contribute to process improvement and strategic initiatives in a fast-paced team.

Qualifications

• MD or DO with an active, unrestricted license.
• Board Certified in an ABMS or AOBMS specialty.
• 5+ years clinical practice experience.
• 2+ years Quality Management experience.
• Intermediate+ proficiency with managed care.
• Basic computer skills including typing, word processing, presentation, and spreadsheet applications.
• Strong telephonic and interpersonal communication skills.
• Proven project management skills.
• Data analysis and interpretation skills.
• Strong presentation skills for clinical and non-clinical audiences.
• Creative problem-solving and team-building abilities.

Responsibilities

• Perform individual case review for appeals and grievances for various health plan and insurance products.
• Handle Department of Insurance/Department of Managed Healthcare and CMS regulatory responses.
• Communicate with UnitedHealthcare medical directors regarding appeals decision rationales and benefit interpretations.
• Coordinate with Regional and Plan medical directors and network management staff on access, network, and quality issues.
• Participate in team meetings focused on communication, feedback, problem solving, and process improvement.

Skills

Telephonic comms

Interpersonal skills

Project management

Data analysis

Presentation skills

Creative problem-solving

Team player

Internet research

Office software

Education

MD/DO with license

Tools

Microsoft Office

Job description

UnitedHealth Group’s UnitedHealthcare arm seeks a Medical Director to lead appeals and grievances clinical review and adjudication across plans. This remote role allows work from anywhere in the U.S. while impacting patient care and policy interpretation.

You will review cases, respond to regulatory bodies, collaborate with medical directors and network staff, and contribute to process improvement and strategic initiatives in a fast-paced team.