Remote Medical Director, Appeals & Grievances (MD/DO)

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

Benefits offered by this job

Comprehensive benefits

Equity stock purchase

401k contribution

Job summary

UnitedHealthcare, a part of UnitedHealth Group, is seeking a Medical Director for Appeals and Grievances. The role focuses on clinical review, adjudication, and regulatory responses for various health plans. It offers remote work from anywhere in the U.S.

and a comprehensive benefits package. The position requires MD or DO, board certification, extensive clinical practice, and quality management experience, with strong communication and project management skills.

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.
• Proven creative problem-solving skills.
• Proven solid team player and team building skills.

Responsibilities

• Perform individual case review for appeals and grievances for health plans and insurance products.
• Respond to regulatory matters from Department of Insurance/DMHC and CMS.
• Communicate with UHMS medical directors regarding appeal rationales and benefit interpretations.
• Coordinate with Regional and Plan medical directors and network management staff on access and quality issues.
• Participate in team meetings focused on communication, problem solving, process improvement, and training.

Skills

Telephonic communication

Project management

Data analysis

Presentation skills

Teamwork

Education

MD or DO with active license

Board Certified in ABMS/AOBMS

Tools

Microsoft Office Suite

Internet Research

Job description

UnitedHealthcare, a part of UnitedHealth Group, is seeking a Medical Director for Appeals and Grievances. The role focuses on clinical review, adjudication, and regulatory responses for various health plans. It offers remote work from anywhere in the U.S.

and a comprehensive benefits package. The position requires MD or DO, board certification, extensive clinical practice, and quality management experience, with strong communication and project management skills.