Remote Medical Director, Appeals & Grievances

UnitedHealth Group; Cypress (CA); Remote; USD 248,500 - 373,000; Full time

Benefits offered by this job

Comprehensive benefits package

401k contribution

Incentive and recognition programs

Job summary

A healthcare organization is seeking a Medical Director for Appeals and Grievances to oversee ongoing clinical reviews and adjudications. This role requires an MD or DO with board certification and extensive clinical experience, including quality management. Key responsibilities include reviewing cases related to medical service provisions and liaising with medical directors. The position offers remote work flexibility and a comprehensive benefits package. Competitive compensation ranges from $248,500 to $373,000 annually based on various factors.

Qualifications

• 5+ years of clinical practice experience required.
• 2+ years of Quality Management experience required.
• Basic computer skills including word processing and spreadsheets.

Responsibilities

• Conduct reviews of appeals and grievances cases for health plans.
• Communicate with medical directors regarding appeals decision rationales.
• Participate in team meetings for process improvement and training.

Skills

Clinical practice experience

Quality Management experience

Presentation skills

Telephonic communication skills

Project management skills

Data analysis skills

Interpersonal communication skills

Creative problem-solving skills

Team building skills

Basic computer skills

Education

MD or DO with active, unrestricted license

Board Certified in ABMS or AOBMS specialty

Job description

A healthcare organization is seeking a Medical Director for Appeals and Grievances to oversee ongoing clinical reviews and adjudications. This role requires an MD or DO with board certification and extensive clinical experience, including quality management. Key responsibilities include reviewing cases related to medical service provisions and liaising with medical directors. The position offers remote work flexibility and a comprehensive benefits package. Competitive compensation ranges from $248,500 to $373,000 annually based on various factors.