Appeals and Grievances Medical Director

6 days ago

Cypress, United States UnitedHealthcare Full time

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 together.**

Work 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 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.

**Required Qualifications**:

- 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
- Familiarity with current medical issues and practices
- Intermediate or higher level of proficiency with managed care
- 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 nonclinical audiences
- Proven creative problem-solving skills
- Proven solid team player and team building skills
- All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
- At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission._
- 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._

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