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

Texas Health Institute; Cypress (CA); Hybrid; USD 238,000 - 358,000; Full time

Benefits offered by this job

Equity stock purchase

401k contribution

Comprehensive benefits package

Job summary

UnitedHealthcare is seeking a Medical Director for Appeals and Grievances to lead clinical review and adjudication across multiple health plans. This remote role offers flexibility to work from anywhere in the U.S. and requires strong clinical and regulatory skills.

The position emphasizes collaboration with medical directors, quality management, and program evaluation, with a path for professional growth within UnitedHealth Group.

Qualifications

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Responsibilities

• Perform individual case review for appeals and grievances for various health plan and insurance products.
• Perform regulatory responses with DOIs and CMS.
• Communicate with UnitedHealthcare medical directors regarding appeals decisions and benefit interpretations.
• Coordinate with regional and plan medical directors on access, network, and quality issues.
• Participate in team meetings focused on communication, feedback, process improvement, and training.
• Provide clinical and strategic input on committees and projects.

Skills

Telephonic communication

Project management

Data analysis

Presentation skills

Team player

Quality management

Managed care proficiency

Communication skills

Microsoft Office

Education

MD or DO with active license

Board Certified in ABMS/AOBMS specialty

5+ years clinical practice

2+ years Quality Management experience

Proficiency with basic computer tools

Tools

Microsoft Office

Job description

UnitedHealthcare is seeking a Medical Director for Appeals and Grievances to lead clinical review and adjudication across multiple health plans. This remote role offers flexibility to work from anywhere in the U.S. and requires strong clinical and regulatory skills.

The position emphasizes collaboration with medical directors, quality management, and program evaluation, with a path for professional growth within UnitedHealth Group.