Appeals M.D PM&R - Remote

At United Healthcare, 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
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The Appeals and Grievances Medical Director is responsible for ongoing clinical review and adjudication of appeals and grievances cases for United Healthcare associated companies. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

• 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 – No Pediatrics
• 5+ years of clinical practice experience

• 2+ years of Quality Management experience
• Intermediate or higher level of proficiency with managed care
• Excellent telephonic communication skills; excellent 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 skills. Internet researching skills
• Solid team player and team building skills
• All employees working remotely will be required to adhere to United Health Group’s Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401(k) contribution (all benefits are subject to eligibility requirements). The salary for this role will range from $269,500 to $425,500 annually based on full‑time employment.

We comply with all minimum wage laws as applicable.

Final date to receive applications: This posting will be available for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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.