Appeals and Grievances Medical Director - PM&R Physician - Remote

$286,104 - $397,743/Yr

UnitedHealth Group - Houston, TX

Full-time - Senior

Remote - Houston, TX

Insurance Carriers and Related Activities

About the position

The Appeals and Grievances Medical Director at UnitedHealthcare is responsible for the clinical review and adjudication of appeals and grievances cases across various health plan and insurance products. This role involves ensuring compliance with regulatory responses and collaborating with medical directors and network management staff to address access and quality issues. The position offers the flexibility to work remotely from anywhere in the U.S.

Responsibilities

• Perform individual case review for appeals and grievances for various health plan and insurance products.
• 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.

Requirements

• MD or DO with an active, unrestricted license
• PM and R Board Certified in an ABMS or AOBMS specialty
• 5+ years 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
• Solid team player and team building skills

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution