Appeals and Grievances Medical Director - Radiation Oncologist Required - Virtual

At UnitedHealthcare, we are simplifying the healthcare experience and creating healthier communities. The Appeals and Grievances Medical Director supports ongoing clinical review and adjudication of appeals and grievances cases for UnitedHealthcare-associated companies. The role offers flexible, remote work from anywhere within the United States. Primary Responsibilities Perform individual case review for appeals and grievances for various health plan and insurance products, including PPO, ASO, HMO, MAPD, and PDP. These appeals arise in response to adverse determinations for medical services related to benefit design, coverage, and clinical criteria of medical policies. Perform Department of Insurance, Department of Managed Healthcare, and CMS regulatory responses. 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 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. 5+ years clinical practice experience. 2+ years quality management experience. Intermediate or higher level proficiency with managed care. Basic computer skills: typing, word processing, presentation, spreadsheet applications, and internet research. 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; familiarity with current medical issues and practices. Proven creative problem‑solving skills. Proven solid team‑player and team‑building skills. Compensation and Benefits Compensation generally ranges from $248,500 to $373,000, including base pay and bonus. In addition, we offer a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401(k) contribution. All benefits are subject to eligibility requirements. All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy. UnitedHealth 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. #J-18808-Ljbffr Texas Health Institute