Remote Medical Director, Appeals & Grievances

UnitedHealth Group; Cypress (CA); Hybrid; USD 238,000 - 358,000; Full time

Benefits offered by this job

Comprehensive benefits

Equity stock purchase

401k contribution

Incentive programs

Job summary

UnitedHealth Group seeks a Medical Director for Appeals and Grievances to adjudicate cases for UnitedHealthcare plans. This remote role allows you to work from anywhere in the U.S., contributing to clinical review, policy interpretation, and collaboration with medical directors and network teams.

You will lead case reviews, advise on regulatory responses, and participate in committees to drive process improvements and staff development.

Qualifications

• MD or DO with an active, unrestricted license.
• Board Certification in an ABMS or AOBMS specialty.
• 5+ years clinical practice experience.
• 2+ years of Quality Management experience.
• Proficiency with managed care.
• Basic computer skills, typing, word processing, presentation, and spreadsheet applications.
• Strong telephonic and interpersonal communication skills.
• Proven project management skills.
• Proven data analysis and interpretation skills.
• Strong presentation skills for clinical and non-clinical audiences.

Responsibilities

• Perform individual case review for appeals and grievances across health plans and products.
• Address regulatory responses from DoI/DMHC and CMS.
• Communicate decision rationales and benefit interpretations with medical directors.
• Coordinate with regional directors and network management on access, network, and quality issues.
• Participate in team meetings and contribute to process improvements and training.
• Provide clinical and strategic input in organizational committees and projects.

Skills

Medical license

Board Certification

Quality management

Managed care

Communication skills

Project management

Data analysis

Presentation skills

Team collaboration

Clinical review

Education

MD/DO

Tools

Office Suite

Job description

UnitedHealth Group seeks a Medical Director for Appeals and Grievances to adjudicate cases for UnitedHealthcare plans. This remote role allows you to work from anywhere in the U.S., contributing to clinical review, policy interpretation, and collaboration with medical directors and network teams.

You will lead case reviews, advise on regulatory responses, and participate in committees to drive process improvements and staff development.