Appeals Medical Director - Remote

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Work at home from anywhere within the U.S. as you take on some tough challenges.

About the Role

As an Appeals and Grievances Medical Director, you will be responsible for ongoing clinical review and adjudication of appeals and grievances cases for UnitedHealthcare associated companies. This role involves collaboration with a dynamic team culture that values clinical and business collaboration, learning, and evolution.

Responsibilities

• Perform individual case review for appeals and grievances for various health plan and insurance products, including PPO, ASO, HMO, MAPD, and PDP, in response to adverse determinations for medical services related to benefit design, coverage, and clinical criteria of medical policies.
• Perform regulatory responses for the Department of Insurance, Department of Managed Healthcare, and CMS.
• Communicate with UnitedHealthcare medical directors regarding appeals decision rationales and benefit interpretations.
• Engage with UnitedHealthcare Regional and Plan medical directors and network management staff on access, availability, network, and quality issues.
• Actively participate in team meetings focused on communication, feedback, problem-solving, process improvement, staff training, evaluation, and sharing program results.
• Provide clinical and strategic input when participating in organizational committees, projects, and task forces.

Requirements

• 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.

Skills

• Proven excellent telephonic and 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, including typing, word processing, presentation, and spreadsheet applications, as well as internet researching skills.
• Proven team player and team-building skills.

All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Pay

Compensation for this specialty generally ranges from $248,500.00 to $373,000.00. Total cash compensation includes base pay and bonus and is based on several factors including but not limited to local labor markets, education, work experience, and may increase over time based on productivity and performance in the role. We comply with all minimum wage laws as applicable.

Benefits

• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).