Medical Director

Appeals And Grievances Medical DirectorAt 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. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing togetherWork at home!What makes your clinical career greater with UnitedHealth Group? You can improve the health of others and help heal the health care system. You can work with in an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere.You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.Primary ResponsibilitiesThe Appeals and Grievances Medical Director is responsible for ongoing clinical review and adjudication of appeals and grievances cases for UnitedHealthcare associated companies. Performance accountabilities include: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 policiesPerform Department of Insurance/Department of Managed Healthcare, and CMS regulatory responsesCommunicate with UnitedHealthcare medical directors regarding appeals decision rationales, and benefit interpretationsCommunicate with UnitedHealthcare Regional and Plan medical directors and network management staff regarding access, availability, network, and quality issuesActively participate in team meetings focused on communication, feedback, problem solving, process improvement, staff training and evaluation, and the sharing of program resultsProvide clinical and strategic input when participating in organizational committees, projects, and task forcesYou'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.Required QualificationsMD or DO with an active, unrestricted licenseBoard Certified in an ABMS or AOBMS specialty5+ years of clinical practice experience2+ years of Quality Management experienceFamiliarity with current medical issues and practicesIntermediate or higher level of proficiency with managed careProven excellent telephonic communication skills; excellent interpersonal communication skillsProven excellent project management skillsProven data analysis and interpretation skillsProven excellent presentation skills for both clinical and non-clinical audiencesProven creative problem-solving skillsProven basic computer skills, typing, word processing, presentation, and spreadsheet applications skills. Internet researching skillsProven solid team player and team building skills*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter PolicyPay 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 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. The salary for this role will range from $248,500 - $373,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.