Appeals and Grievances Medical Director - Radiology Specialty Required - Remote
Cypress, California
Employer: UnitedHealth Group
Industry: Medical & Clinical Operations
Salary: Competitive
Job type: Full-Time
At 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 equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.
The Appeals and Grievances Medical Director is responsible for ongoing clinical review and adjudication of appeals and grievances cases for UnitedHealthcare associated companies.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
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 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 Qualifications:
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, Washington, or Washington, D.C. Residents Only: The salary range for this role is $286,104 to $397,743 annually. Salary Range is defined as total cash compensation at target. The actual range and pay mix of base and bonus is variable based upon experience and metric achievement. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.
Application Deadline: This will be posted 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.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
The Appeals and Grievances Medical Director is responsible for ongoing clinical review and adjudication of appeals and grievances cases for UnitedHealthcare associated companies.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
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 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 the sharing of program results
- Provide clinical and strategic input when participating in organizational committees, projects, and task forces
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 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 Qualifications:
- MD or DO with an active, unrestricted license
- Board Certified in an ABMS or AOBMS specialty
- 5+ years of clinical practice experience
- 2+ years 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 UnitedHealth Group's Telecommuter Policy
California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, Washington, or Washington, D.C. Residents Only: The salary range for this role is $286,104 to $397,743 annually. Salary Range is defined as total cash compensation at target. The actual range and pay mix of base and bonus is variable based upon experience and metric achievement. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.
Application Deadline: This will be posted 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.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
Created: 2024-09-28
Reference: 2242931
Country: United States
State: California
City: Cypress
About UnitedHealth Group
Founded in: 1977
Number of Employees: 300000
Website: https://www.unitedhealthgroup.com/
Career site: https://careers.unitedhealthgroup.com/
Similar jobs:
-
Medical Director, California - Remote
Optum West in El Segundo, California💸 $300000 per year -
Director Service Unit RN - Arques Medical Offices
Kaiser Permanente in Sunnyvale, California💸 $185900 - $240570 per year -
Medical Director of the Robert G. Kardashian Center for Esophageal Health
University of California, Los Angeles in Los Angeles, California -
Regional Medical Sales Director
Sayva Solutions in La Jolla, California💸 $100000 - $140000 per year -
Director, Financial Planning & Analysis, Medical Financial Operations
Kaiser Permanente in Sacramento, California💸 $197900 - $256080 per year -
Optum California - Community Medical Director
UnitedHealth Group in Pasadena, California -
Medical Director Utilization Management
Dignity Health in Bakersfield, California -
Medical Director - Urgent Care
Vituity in Oceanside, California -
Physician Associate Hospice Medical Director
Amedisys in Fresno, California -
Medical Director - Hospital Medicine
Vituity in Saint Helena, California -
Medical Director - Clinical Advocacy - Gender Dysphoria - Remote
UnitedHealth Group in Los Angeles, California -
Director Medical Staff Services
Dignity Health in Los Angeles, California -
Medical Director Ambassador - Hospital Medicine
Vituity in Emeryville, California -
Assistant Medical Director - Advanced Provider - Urgent Care
Vituity in Oceanside, California💸 $65 - $78 per hour -
Director Nursing Medical Surgical ICU
Dignity Health in Woodland, California -
Medical Director, California - Remote
UnitedHealth Group in El Segundo, California💸 $300000 per year -
Medical Director
Premise Health in Folsom, California -
Medical Director-Primary Care
Premise Health in Burbank, California -
Medical Director - Post-Acute Care Management - naviHealth - Physiatrist - Remote
UnitedHealth Group in Los Angeles, California -
Assistant Medical Director - Emergency Medicine
Vituity in Selma, California