Job Details

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 equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing togetherWork at home!You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.Primary Responsibilities:The Appeals and Grievances Medical Director is responsible for ongoing clinical review and adjudication of appeals and grievances cases for UnitedHealthcare associated companies. Performance accountabilities include:Perform individual case review for appeals and grievances for various health plan and insurance products, which may include PPO, ASO, HMO, MAPD, and PDP. The appeals are in response 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.Required Qualifications:MD or DO with an active, unrestricted licenseBoard Certified in an ABMS or AOBMS specialty - No Pediatricians5+ years of clinical practice experience2+ years of Quality Management experienceIntermediate or higher level of proficiency with managed careBasic computer skills, typing, word processing, presentation, and spreadsheet applications skills. Internet researching skillsProven excellent presentation skills for both clinical and non-clinical audiences. Familiarity with current medical issues and practicesProven excellent telephonic communication skills; excellent interpersonal communication skillsProven excellent project management skillsProven data analysis and interpretation skillsProven creative problem-solving skillsProven solid team player and team building skills*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.Compensation for this specialty generally ranges from $248,500.00 - $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. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives.At UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.J-18808-Ljbffr