Appeals and Grievances Medical Director - Virtual
Company: UnitedHealth Group Inc.
Posted on: May 5, 2022
UnitedHealthcare is a company that's on the rise. We're
expanding in multiple directions, across borders and, most of all,
in the way we think. Here, innovation isn't about another gadget,
it's about transforming the health care industry. Ready to make a
difference? Make yourself at home with us and start doing your
life's best work.(sm)
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 telecommute* 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. 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
* 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
What makes your clinical career greater with UnitedHealth Group?
You can improve the health of others and help heal the health care
system. You can work with in an incredible team culture; a clinical
and business collaboration that is learning and evolving every day.
And, when you contribute, you'll open doors for yourself that
simply do not exist in any other organization, anywhere.
You'll be rewarded and recognized for your performance in an
environment that will challenge you and give you clear direction on
what it takes to succeed in your role as well as provide
development for other roles you may be interested in.
* 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
* Excellent telephonic communication skills; excellent
interpersonal communication skills
* Excellent project management skills
* Data analysis and interpretation skills
* Excellent presentation skills for both clinical and nonclinical
audiences. Familiarity with current medical issues and
* Creative problemsolving skills
* Basic computer skills, typing, word processing, presentation, and
spreadsheet applications skills. Internet researching skills
* Solid team player and team building skills
To protect the health and safety of our workforce, patients and
communities we serve, UnitedHealth Group and its affiliate
companies require all employees to disclose COVID-19 vaccination
status prior to beginning employment. In addition, some roles and
locations require full COVID-19 vaccination, including boosters, as
an essential job function. UnitedHealth Group adheres to all
federal, state and local COVID-19 vaccination regulations as well
as all client COVID-19 vaccination requirements and will obtain the
necessary information from candidates prior to employment to ensure
compliance. Candidates must be able to perform all essential job
functions with or without reasonable accommodation. Failure to meet
the vaccination requirement may result in rescission of an
employment offer or termination of employment
At OptumCare, we've found that putting clinicians at the center of
care is the best way to improve lives. Our physician-led
organization is one of the most dynamic and progressive health care
organizations in the world, serving over 17 million people through
more than 45,000 aligned physicians and 9,000 advanced practice
clinicians. You will find our team working in local clinics,
surgery centers and urgent care centers, within care models focused
on managing risk, higher quality outcomes and driving change
through collaboration and innovation. Learn more at
Would you thrive with OptumCare?
* Do you practice evidence-based medicine?
* Are you seeking a practice focused on patient-centered quality
care, not volume?
* Are you a team player - comfortable delegating and empowering
* Are you constantly seeking better ways to do things?
* Do you want to be part of something better?
Careers with UnitedHealthcare. Let's talk about opportunity. Start
with a Fortune 5 organization that's serving more than 85 million
people already and building the industry's singular reputation for
bold ideas and impeccable execution. Now, add your energy, your
passion for excellence, your near-obsession with driving change for
the better. Get the picture? UnitedHealthcare is serving employers
and individuals, states and communities, military families and
veterans where ever they're found across the globe. We bring them
the resources of an industry leader and a commitment to improve
their lives that's second to none. This is no small opportunity.
It's where you can do your life's best work.(sm)
Colorado, Connecticut or Nevada Residents Only: The salary range
for Colorado residents is $254,600 to $295,200. The salary range
for Connecticut / Nevada residents is $254,600 to $295,200. The
range and pay mix of base and bonus is variable based upon
experience and metric achievement. Pay is based on several factors
including but not limited to education, work experience,
certifications, etc. In addition to your salary, UnitedHealth Group
offers 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
UnitedHealth Group, you'll find a far-reaching choice of benefits
* All Telecommuters will be required to adhere to UnitedHealth
Group's Telecommuter Policy.
Diversity creates a healthier atmosphere: UnitedHealth Group is an
Equal Employment Opportunity/Affirmative Action employer and all
qualified applicants will receive consideration for employment
without regard to race, color, religion, sex, age, national origin,
protected veteran status, disability status, sexual orientation,
gender identity or expression, marital status, genetic information,
or any other characteristic protected by law.
UnitedHealth Group is a drug free workplace. Candidates are
required to pass a drug test before beginning employment.
Keywords: UnitedHealth Group Inc., Cypress , Appeals and Grievances Medical Director - Virtual, Executive , Cypress, California
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