Remote Radiology Appeals Medical Director

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

Benefits offered by this job

Remote work flexibility

Competitive compensation

Comprehensive benefits

Equity stock purchase opportunities

401(k)

Professional development

Job summary

UnitedHealth Group’s UnitedHealthcare division seeks an Appeals Medical Director specializing in Radiology. You will ensure fair, evidence-based review of member appeals and contribute to improved healthcare outcomes across the country, with remote collaboration among physicians, nurses, and clinicians.

This role combines regulatory expertise, independent medical judgment, and leadership across enterprise initiatives, offering growth within the organization and exposure to Medicare and

Qualifications

• MD or DO degree with an active, unrestricted medical license.
• Board Certification in an ABMS or AOBMS-recognized specialty.
• Proven solid clinical judgment and ability to apply evidence-based medicine in utilization management and appeals.
• Excellent written and verbal communication skills.

Responsibilities

• Conduct independent clinical reviews of member appeals and grievances involving Medicare and Commercial health plans, including PPO, HMO, ASO, MAPD, and PDP products.
• Evaluate appeals related to adverse coverage determinations for medical services, applying evidence-based medicine, regulatory requirements, and plan benefits.
• Prepare and support responses to inquiries from regulatory agencies, including CMS, Departments of Insurance, and Departments of Managed Health Care.
• Collaborate with fellow Medical Directors regarding appeal determinations, clinical rationale, benefit interpretation, and policy application.
• Participate in departmental meetings focused on quality improvement, process enhancement, clinical consistency, education, and team development.
• Provide clinical expertise and strategic insights on organizational committees, projects, and enterprise initiatives.

Skills

Clinical judgment

Evidence-based medicine

Written communication

Verbal communication

Education

MD or DO degree

Active medical license

Board Certification (ABMS/AOBMS)

Job description

UnitedHealth Group’s UnitedHealthcare division seeks an Appeals Medical Director specializing in Radiology. You will ensure fair, evidence-based review of member appeals and contribute to improved healthcare outcomes across the country, with remote collaboration among physicians, nurses, and clinicians.

This role combines regulatory expertise, independent medical judgment, and leadership across enterprise initiatives, offering growth within the organization and exposure to Medicare and