Remote Medical Director – Appeals & Quality

Texas Health Institute; Cypress, Northern (CA, KY); Hybrid; USD 249,000 - 373,000; Full time

Benefits offered by this job

Comprehensive benefits package

Equity stock purchase

401k contribution

Job summary

UnitedHealthcare is seeking a licensed MD or DO with extensive clinical and quality management experience to join a remote team delivering appeals and regulatory responses. You’ll review cases, engage with medical directors, and help shape care design across plans.

This role offers telecommuting from anywhere in the U.S., a comprehensive benefits package, and performance-based recognition. Candidates should have board certification, 5+ years clinical practice, and strong communication and

Qualifications

• MD or DO with an active, unrestricted license.
• Board Certified in an ABMS or AOBMS specialty.
• 5+ years of clinical practice experience
• 2+ years of Quality Management experience
• Intermediate or higher level of proficiency with managed care
• 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 basic computer skills, typing, word processing, presentation, and spreadsheet applications skills. Internet researching skills
• Proven team player and team building skills

Responsibilities

• Perform individual case review for appeals and grievances for various health plan products.
• Perform regulatory responses for Department of Insurance/Department of Managed Healthcare and CMS.
• Communicate with medical directors regarding appeals and benefit interpretations.
• Coordinate with regional and plan medical directors on access, network, and quality issues.
• Participate in team meetings and contribute to process improvement and training.
• Provide clinical and strategic input in committees and projects.

Skills

Telephonic communication

Interpersonal communication

Project management

Data analysis

Presentation skills

Problem solving

Team player

Computer skills

Typing/Word processing

Spreadsheet skills

Education

MD or DO license

Board certification (ABMS/AOBMS)

Tools

Managed care proficiency

Job description

UnitedHealthcare is seeking a licensed MD or DO with extensive clinical and quality management experience to join a remote team delivering appeals and regulatory responses. You’ll review cases, engage with medical directors, and help shape care design across plans.

This role offers telecommuting from anywhere in the U.S., a comprehensive benefits package, and performance-based recognition. Candidates should have board certification, 5+ years clinical practice, and strong communication and