Remote Medical Director, Appeals & Grievances

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

Job summary

The Appeals and Grievances Medical Director at UnitedHealthcare oversees ongoing clinical review and adjudication of appeals and grievances for multiple health plans. You will apply clinical criteria, communicate decision rationales, and coordinate with medical directors and network staff to ensure accurate benefit interpretations.

This role offers full remote work across the United States, with limited in-office requirements in certain markets; requires MD or DO with an active license, board

Qualifications

• MD or DO with an active, unrestricted license.
• Board certification in ABMS/AOBMS specialty.
• 5+ years of clinical practice experience.
• 2+ years of Quality Management experience.
• Strong telephonic communication and interpersonal skills.
• Proven data analysis and presentation abilities.

Responsibilities

• Perform individual case review for appeals and grievances across health plans (PPO, HMO, MAPD, PDP).
• Respond to regulatory requests from DoI/DMHC and CMS.
• Communicate decision rationales to medical directors and plan staff.
• Collaborate with network management on access and quality issues.
• Participate in team meetings for process improvement and reporting.
• Contribute clinical input in organizational committees and projects.

Skills

Communication skills

Project management

Data analysis

Presentation skills

Team player

Education

MD or DO with license

Tools

MS Office

Job description

The Appeals and Grievances Medical Director at UnitedHealthcare oversees ongoing clinical review and adjudication of appeals and grievances for multiple health plans. You will apply clinical criteria, communicate decision rationales, and coordinate with medical directors and network staff to ensure accurate benefit interpretations.

This role offers full remote work across the United States, with limited in-office requirements in certain markets; requires MD or DO with an active license, board