Appeals M.D. - PM&R Required - Remote

Position Overview

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. Join us to start Caring. Connecting. Growing together. 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 work remotely from anywhere within the U.S. as you take on some tough challenges.

Key Responsibilities

• Perform individual case review for appeals and grievances for various health plan and insurance products, including PPO, ASO, HMO, MAPD, and PDP. This involves reviewing appeals in response to adverse determinations for medical services related to benefit design, coverage, and the application of clinical criteria of medical policies.
• Perform regulatory responses in accordance with the Department of Insurance/Department of Managed Healthcare and CMS guidelines.
• 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 license
• Board Certified in an ABMS or AOBMS specialty - No Pediatrics
• 5+ years of clinical practice experience

Preferred Qualifications

• 2+ years of Quality Management experience
• Intermediate or higher level of proficiency with managed care
• Excellent telephonic and 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
• Basic computer skills including typing, word processing, presentation, and spreadsheet applications; proficient in internet research
• Solid team player with strong team building skills
• Adherence to UnitedHealth Group's Telecommuter Policy for all remote employees

Benefits & Perks

• Salary: $269,500 to $425,500 annually based on full-time employment
• Benefits: Comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all subject to eligibility requirements)
• Location: Remote (Anywhere within the U.S.)