Remote Radiology Appeals Medical Director

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

Benefits offered by this job

Remote work flexibility

Competitive compensation

Comprehensive benefits

401(k) and stock purchase

Job summary

UnitedHealthcare is seeking an Appeals Medical Director specializing in Radiology to ensure fair, evidence-based review of member appeals. The role supports improved healthcare outcomes nationwide while enabling remote collaboration with a multidisciplinary team.

You will apply independent medical judgment, regulatory expertise, and cross-functional leadership to advance quality and policy interpretation within the Appeals and Grievances area.

Qualifications

• MD or DO license with active, unrestricted medical license.
• Board Certification in an ABMS or AOBMS-recognized specialty.
• Strong clinical judgment and evidence-based decision making.
• Excellent written and verbal communication skills.
• Remote work compliance with Telecommuter Policy.

Responsibilities

• Conduct independent clinical reviews of member appeals and grievances across Medicare and Commercial plans.
• Evaluate adverse coverage determinations using evidence-based medicine and regulatory requirements.
• Prepare responses to inquiries from CMS and state Departments of Insurance.
• Collaborate with Medical Directors on appeal determinations and policy interpretation.
• Participate in quality improvement and clinical consistency initiatives.
• Provide strategic insights on enterprise initiatives and committees.

Skills

Clinical judgment

Evidence-based medicine

Written and verbal communication

Education

MD/DO license

Job description

UnitedHealthcare is seeking an Appeals Medical Director specializing in Radiology to ensure fair, evidence-based review of member appeals. The role supports improved healthcare outcomes nationwide while enabling remote collaboration with a multidisciplinary team.

You will apply independent medical judgment, regulatory expertise, and cross-functional leadership to advance quality and policy interpretation within the Appeals and Grievances area.