Remote Appeals Medical Director, Radiology

UnitedHealthcare; Cypress (CA); Remote; USD 248,000 - 373,000; Full time

Benefits offered by this job

Remote work

Job summary

UnitedHealth Group in the United States is seeking an Appeals Medical Director in Radiology for a remote role. You will oversee clinical review and adjudication of appeals and grievances across plans, contributing to quality care and regulatory compliance.

The role requires MD or DO, board certification, 5+ years of clinical practice, and strong communication and data analysis skills. You will work with medical directors and network staff to improve access, quality and policy adherence.

Qualifications

• MD or DO with an active, unrestricted license.
• Board certification by ABMS or AOBMS.
• 5+ years of clinical practice experience.
• 2+ years of quality management experience.
• Familiarity with current medical issues and managed care.
• Proven telephonic and interpersonal communication skills.
• Proven data analysis and interpretation skills.
• Proven presentation skills for clinical and non-clinical audiences.
• Proven creative problem solving and teamwork.
• Proficient with basic computer skills and internet research.

Responsibilities

• Perform individual case review for appeals and grievances for various plans.
• Respond to regulatory reviews from DO/DMHC and CMS.
• Communicate decision rationales and benefit interpretations with medical directors.
• Coordinate with regional and plan medical directors on access and network quality.
• Participate in team meetings focused on communication, feedback, problem solving and process improvement.
• Provide clinical and strategic input in committees, projects and task forces.

Skills

MD/DO license

Board Certification

Clinical experience

Quality management

Telephonic communication

Data analysis

Presentation skills

Problem solving

Computer skills

Team player

Job description

UnitedHealth Group in the United States is seeking an Appeals Medical Director in Radiology for a remote role. You will oversee clinical review and adjudication of appeals and grievances across plans, contributing to quality care and regulatory compliance.

The role requires MD or DO, board certification, 5+ years of clinical practice, and strong communication and data analysis skills. You will work with medical directors and network staff to improve access, quality and policy adherence.