Appeals and Grievances Medical Director Reconsiderations

UnitedHealthcare is seeking an Appeals and Grievances Medical Director to join their team. This role involves the clinical review and adjudication of appeals and grievances cases for various health plan and insurance products. The position offers the flexibility to work remotely from anywhere within the U.S., contributing to the company's mission of simplifying healthcare and improving quality care.

Practice Info

• Work at home from anywhere within the U.S.

Responsibilities

• Perform individual case review for appeals and grievances for various health plan and insurance products, which may include PPO, ASO, HMO, MAPD, and PDP
• 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

Compensation

• Compensation for this specialty generally ranges from $248,500 - $373,000
• Total cash compensation includes base pay and bonus
• Compensation 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

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution

Requirements

• MD or DO with an active, unrestricted license
• Board Certified in an ABMS or AOBMS specialty - No Pediatricians
• 5+ years of 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
• Internet researching skills
• Proven excellent presentation skills for both clinical and non-clinical audiences
• Familiarity with current medical issues and practices
• Proven excellent telephonic communication skills; excellent interpersonal communication skills
• Proven excellent project management skills
• Proven data analysis and interpretation skills
• Proven creative problem-solving skills
• Proven solid team player and team building skills