Appeals and Grievances Medical Director - Gastroenterologist Required - Virtual
Company: UnitedHealth Group
Location: Cypress
Posted on: June 18, 2022
Job Description:
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)Work at home! You'll enjoy the flexibility to
telecommute* 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
- 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,
anywhereYou'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.Required
Qualifications:
- MD or DO with an active, unrestricted license
- Board Certified in an ABMS or AOBMS specialty
- 5+ years clinical practice experience
- 2+ years 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 skillsPreferred Qualifications:
- Excellent telephonic communication skills; excellent
interpersonal communication skills
- Excellent project management skills
- Data analysis and interpretation skills
- Excellent presentation skills for both clinical and
non-clinical audiences. Familiarity with current medical issues and
practices
- Creative problem-solving 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.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)*All Telecommuters will
be required to adhere to UnitedHealth Group's Telecommuter
PolicyDiversity 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, Cypress , Appeals and Grievances Medical Director - Gastroenterologist Required - Virtual, Executive , Cypress, California
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