Senior Remote Appeals Medical Director

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

Benefits offered by this job

Remote work within the U.S.

Competitive benefits

Job summary

UnitedHealth Group's UnitedHealthcare division seeks an Appeals and Grievances Medical Director to lead clinical reviews and adjudicate cases across multiple health plans. This remote position offers high impact work, cross-functional collaboration, and ongoing professional development.

You will evaluate complex appeals, ensure compliance with policies, and provide expert input to improve care access and outcomes. The role includes flexible remote work options and competitive benefits.

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.
• Proven telephonic and interpersonal communication skills.
• Proven project management, data analysis and presentation skills.

Responsibilities

• Perform individual case review for appeals and grievances across health plans and products.
• Handle regulatory responses from insurance and CMS bodies.
• Communicate decision rationales to medical directors and staff.
• Collaborate with regional and plan medical directors on access and network issues.
• Participate in team meetings for process improvement and training.
• Contribute clinically and strategically in organizational committees.

Skills

Telephonic communication

Project management

Data analysis

Presentation skills

Teamwork

Education

MD/DO with active license

Board Certification (ABMS/AOBMS)

Tools

MS Office

Excel

PowerPoint

Job description

UnitedHealth Group's UnitedHealthcare division seeks an Appeals and Grievances Medical Director to lead clinical reviews and adjudicate cases across multiple health plans. This remote position offers high impact work, cross-functional collaboration, and ongoing professional development.

You will evaluate complex appeals, ensure compliance with policies, and provide expert input to improve care access and outcomes. The role includes flexible remote work options and competitive benefits.