Remote Medical Director - Appeals & Radiation Oncology

UnitedHealthcare; Cypress (CA); À distance; USD 249 000 - 373 000; Plein temps

Résumé du poste

UnitedHealth Group in Cypress, CA, is seeking an Appeals Medical Director for Radiation Oncology. This remote role involves ongoing clinical review and adjudication of appeals and grievances across multiple health plans, with the ability to work from anywhere in the U.S.

In-office requirement applies for certain locations. The role requires an MD or DO with an active license, board certification, and 5+ years of clinical practice plus 2+ years in Quality Management.

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.
• Familiarity with current medical issues and practices.
• Intermediate or higher level of proficiency with managed care.
• Proven telephonic and interpersonal communication skills.
• Proven data analysis and interpretation skills.
• Proven presentation skills for clinical and non-clinical audiences.
• Proven basic computer skills (typing, word processing, presentation, spreadsheets).

Responsabilités

• Perform individual case review for appeals and grievances for various health plans.
• Handle Department of Insurance/Department of Managed Healthcare, and CMS regulatory responses.
• Communicate with medical directors regarding appeals rationales and benefit interpretations.
• Coordinate with Regional and Plan medical directors regarding access, network, and quality issues.
• Participate in team meetings on communication, problem solving and process improvement.
• Provide clinical and strategic input in committees and projects.

Connaissances

Telephonic communication

Data analysis

Presentation skills

Team player

Communication skills

Formation

MD/DO with active license

Board Certification in ABMS/AOBMS

Outils

Microsoft Word

Microsoft Excel

PowerPoint

Internet research

Description du poste

UnitedHealth Group in Cypress, CA, is seeking an Appeals Medical Director for Radiation Oncology. This remote role involves ongoing clinical review and adjudication of appeals and grievances across multiple health plans, with the ability to work from anywhere in the U.S.

In-office requirement applies for certain locations. The role requires an MD or DO with an active license, board certification, and 5+ years of clinical practice plus 2+ years in Quality Management.