Medical Director Appeals and Grievances
4 days ago
At UnitedHealthcare, we're simplifying the healthcare 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 healthcare system of tomorrow, making it more responsive, affordable, and equitable.
Job Summary:The Medical Director Appeals and Grievances is responsible for ongoing clinical review and adjudication of appeals and grievances cases for UnitedHealthcare associated companies.
Key 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.
- Communicate with UnitedHealthcare medical directors regarding appeals decision rationales and benefit interpretations.
- Actively participate in team meetings focused on communication, feedback, problem-solving, process improvement, staff training, and evaluation.
- Provide clinical and strategic input when participating in organizational committees, projects, and task forces.
- 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.
- Excellent telephonic communication skills and interpersonal communication skills.
- Excellent project management skills.
- Data analysis and interpretation skills.
- Excellent presentation skills for both clinical and non-clinical audiences.
- Creative problem-solving skills.
- Basic computer skills, typing, word processing, presentation, and spreadsheet applications skills.
- Solid team player and team building skills.
At UnitedHealth Group, our mission is to help people live healthier lives and make the healthcare system work better for everyone. We believe everyone 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.
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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