Appeals M.D. Cardiologist Requried - Remote

At United Healthcare, we simplify the health care experience, creating healthier communities and removing barriers to quality care. The Appeals and Grievances Medical Director is responsible for ongoing clinical review and adjudication of appeals and grievances cases for United Healthcare associated companies.

Location:

Remote from anywhere within the U.S. All employees working remotely must adhere to United Health Group's Telecommuter Policy.

• Perform individual case review for appeals and grievances for various health plan and insurance products (PPO, ASO, HMO, MAPD, PDP). Cases arise from adverse determinations for medical services related to benefit design, coverage and application of clinical criteria.
• Respond to Department of Insurance, Department of Managed Healthcare and CMS regulatory requests.
• Communicate with United Healthcare medical directors regarding appeal decision rationales and benefit interpretations.
• Communicate with United Healthcare Regional and Plan medical directors and network management staff concerning access, availability, network and quality issues.
• Participate in team meetings focused on communication, feedback, problem solving, process improvement, staff training and program result sharing.
• Provide clinical and strategic input in organizational committees, projects and task forces.

• MD or DO with an active, unrestricted license.
• Board Certified in an ABMS or AOBMS specialty (excluding Pediatrics).
• 5+ years of clinical practice experience.

• 2+ years of quality management experience.
• Intermediate or higher 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: typing, word processing, presentation and spreadsheet applications; internet researching skills.
• Solid team player and team‑building skills.

Salary range: $ to $ annually for full‑time employment. Benefits include a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401(k) contribution (subject to eligibility). We comply with all minimum wage laws.

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, protected veteran status or any other characteristic protected by local, state or federal laws, rules or regulations.

Candidates are required to pass a drug test before beginning employment.