[Hiring] Appeals Medical Director @UnitedHealth Group

Role Description

The Appeals and Grievances Medical Director is responsible for ongoing clinical review and adjudication of appeals and grievances cases for UnitedHealthcare associated companies. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

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

Qualifications

• MD or DO with an active, unrestricted license.
• Board Certified in an ABMS or AOBMS specialty.
• 5+ years clinical practice experience.
• 2+ years of Quality Management experience.
• Intermediate or higher level of proficiency with managed care.
• Basic computer skills, typing, word processing, presentation, and spreadsheet applications skills.
• Proven excellent telephonic communication skills; excellent 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 solid team player and team building skills.

Requirements

• Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc.
• The salary for this role will range from $248,500 - $373,000 annually based on full-time employment.
• We comply with all minimum wage laws as applicable.

Benefits

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

Company Description

At UnitedHealth Group, our mission is to help people live healthier lives and help make the health system work better for everyone. Together, we are shaping the future of healthcare by harnessing technology and innovation to make care simpler to navigate, more affordable and more connected for the people we serve.

• Committed to creating an inclusive workplace where everyone feels welcomed, valued, heard and respected.
• Empowering people to bring their authentic selves to work.
• Strengthening our collective impact through diverse talents, backgrounds, experiences and perspectives.