Remote Medical Director, Appeals & Grievances

UnitedHealth Group; United States; Remote; USD 249,000 - 373,000; Full time

Job summary

UnitedHealth Group seeks a Medical Director for Appeals and Grievances to lead clinical reviews of appeals across multiple health plans and products. You'll ensure regulatory responses and collaborate with medical directors and network management on access and quality issues.

Requires MD/DO with active license, board certification, 5+ years in clinical practice, and 2+ years in quality management. Remote work from anywhere in the U.S. is available.

Qualifications

• MD or DO with an active, unrestricted license.
• Board Certified in an ABMS or AOBMS specialty.
• 5+ years clinical practice experience.
• 2+ years of Quality Management experience.
• Intermediate or higher level of proficiency with managed care.
• Basic computer skills, typing, word processing, presentation, and spreadsheet applications skills.
• Proven excellent telephonic communication skills; excellent interpersonal communication skills.
• Proven excellent project management skills.
• Proven data analysis and interpretation skills.
• Proven excellent presentation skills for both clinical and non-clinical audiences.
• Familiarity with current medical issues and practices.

Responsibilities

• Perform individual case review for appeals and grievances for various health plan and insurance products, which may include PPO, ASO, HMO, MAPD, and PDP.
• Perform Department of Insurance/Department of Managed Healthcare, and CMS regulatory responses
• Communicate with UnitedHealthcare medical directors regarding appeals decision rationales, and benefit interpretations
• Communicate with UnitedHealthcare Regional and Plan medical directors and network management staff regarding access, availability, network, and quality issues
• Actively participate in team meetings focused on communication, feedback, problem solving, process improvement, staff training and evaluation, and the sharing of program results
• Provide clinical and strategic input when participating in organizational committees, projects, and task forces

Skills

Clinical practice experience

Quality management

Telephonic communication

Data analysis

Presentation skills

Project management

Interpersonal communication

Education

MD or DO with active license

Board Certified in ABMS or AOBMS specialty

Job description

UnitedHealth Group seeks a Medical Director for Appeals and Grievances to lead clinical reviews of appeals across multiple health plans and products. You'll ensure regulatory responses and collaborate with medical directors and network management on access and quality issues.

Requires MD/DO with active license, board certification, 5+ years in clinical practice, and 2+ years in quality management. Remote work from anywhere in the U.S. is available.