Appeals and Grievances Medical Director - Otolaryngology; ENT Specialty - Virtual - Remote

Primary 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. 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 United Healthcare medical directors regarding appeals decision rationales, and benefit interpretations
• Communicate with United Healthcare 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

• 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 non-clinical audiences
• Proven creative problem-solving skills
• Proven basic computer skills, typing, word processing, presentation, and spreadsheet applications skills. Internet researching skills
• Proven solid team player and team building skills

Compensation for this specialty generally ranges from $ to $. Total cash compensation includes base pay and bonus and is based on several factors including but not limited to local labor markets, education, work experience and may increase over time based on productivity and performance in the role. We comply with all minimum wage laws as applicable.

In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives.

All employees working remotely will be required to adhere to United Health Group's Telecommuter Policy.

United Health Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

United Health Group is a drug‑free workplace. Candidates are required to pass a drug test before beginning employment.