Remote MD: Appeals & Grievances Medical Director

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

Benefits offered by this job

Comprehensive benefits package

Equity stock purchase

401k contribution

Job summary

UnitedHealthcare is seeking an Appeals and Grievances Medical Director to oversee clinical review and adjudication of appeals across health plans. This remote role offers the flexibility to work from anywhere in the U.S.

You will perform case reviews, respond to regulatory inquiries, collaborate with medical directors, and contribute to process improvements. The position requires an MD/DO with board certification and extensive clinical/quality management experience.

Qualifications

• MD or DO with active, unrestricted license required.
• Board certification in an ABMS/AOBMS specialty is required.
• Minimum 5+ years of clinical practice experience.
• Minimum 2+ years in Quality Management.
• Proficiency with managed care concepts and regulatory requirements.
• Strong project management and data analysis capabilities.
• Excellent telephonic and interpersonal communication skills.
• Solid presentation skills for clinical and non-clinical audiences.
• Ability to contribute to committees and drive process improvements.

Responsibilities

• Perform individual case review for appeals and grievances across health plans and products.
• Respond to regulatory requests from DOIs and CMS as applicable.
• Communicate rationale to medical directors and network staff regarding decisions.
• Collaborate with regional and plan medical directors on access, network, and quality issues.
• Participate in team meetings and drive program improvements and staff development.
• Provide clinical and strategic input on organizational projects and task forces.

Skills

MD/DO medical degree

Board Certified

Quality Management experience

Clinical practice experience

Project management skills

Data analysis and interpretation

Telephonic/interpersonal communication

Presentation skills

Regulatory knowledge

Education

MD or DO degree

Tools

Computer literacy

Job description

UnitedHealthcare is seeking an Appeals and Grievances Medical Director to oversee clinical review and adjudication of appeals across health plans. This remote role offers the flexibility to work from anywhere in the U.S.

You will perform case reviews, respond to regulatory inquiries, collaborate with medical directors, and contribute to process improvements. The position requires an MD/DO with board certification and extensive clinical/quality management experience.