UnitedHealthcare
Medical Director of Appeals and Grievances - PM&R Physician - Remote
UnitedHealthcare, Cypress, California, United States, 90630
At UnitedHealthcare, we are dedicated to improving the health care experience, fostering healthier communities, and eliminating barriers to quality care. The impact of your work here touches the lives of millions, contributing to a better tomorrow in health care. If you are ready to make a meaningful difference, we invite you to join us in
Caring. Connecting. Growing together. This is an exciting opportunity to work remotely from anywhere within the U.S. as you tackle challenging cases in the health care sector. Key Responsibilities: Conduct thorough clinical reviews and adjudications for appeals and grievances across various health plans and insurance products, including PPO, ASO, HMO, MAPD, and PDP. These appeals concern adverse determinations for medical services related to benefit design and coverage. Prepare responses in compliance with Department of Insurance, Department of Managed Health Care, and CMS regulations. Engage with UnitedHealthcare medical directors to discuss appeal decision rationale and benefit interpretations. Collaborate with Regional and Plan medical directors and network management teams to address access, availability, network, and quality concerns. Participate in team meetings focused on communication, feedback, problem-solving, process improvement, staff training, evaluation, and sharing program outcomes. Provide clinical and strategic input in organizational committees, projects, and task forces. This role not only allows you to improve the health of others but also to contribute to the transformation of the health care system. You will be part of a dynamic team that encourages collaboration, learning, and evolving every day. Your contributions will open doors for career advancement that are unique to our organization. Salary and Benefits: Compensation for this position typically ranges between $238,000 and $357,500. This includes base pay and potential bonuses, determined by factors such as local labor markets, education, work experience, and performance. In addition to salary, we offer a comprehensive benefits package, incentive programs, equity opportunities, and a 401k plan (subject to eligibility requirements). At UnitedHealth Group, we are driven by our mission to help people lead healthier lives and enhance the health system for everyone. We believe that everyone, regardless of race, gender, sexuality, age, location, or income, deserves the chance to live their healthiest life. We are committed to addressing health disparities and improving health outcomes, particularly for historically marginalized groups. As an Equal Employment Opportunity employer, UnitedHealth Group ensures that all qualified applicants receive consideration for employment without discrimination based on race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or veteran status, among other characteristics protected by law. All employees working remotely will be required to comply with UnitedHealth Group's Telecommuter Policy. A drug test will be required prior to employment.
Caring. Connecting. Growing together. This is an exciting opportunity to work remotely from anywhere within the U.S. as you tackle challenging cases in the health care sector. Key Responsibilities: Conduct thorough clinical reviews and adjudications for appeals and grievances across various health plans and insurance products, including PPO, ASO, HMO, MAPD, and PDP. These appeals concern adverse determinations for medical services related to benefit design and coverage. Prepare responses in compliance with Department of Insurance, Department of Managed Health Care, and CMS regulations. Engage with UnitedHealthcare medical directors to discuss appeal decision rationale and benefit interpretations. Collaborate with Regional and Plan medical directors and network management teams to address access, availability, network, and quality concerns. Participate in team meetings focused on communication, feedback, problem-solving, process improvement, staff training, evaluation, and sharing program outcomes. Provide clinical and strategic input in organizational committees, projects, and task forces. This role not only allows you to improve the health of others but also to contribute to the transformation of the health care system. You will be part of a dynamic team that encourages collaboration, learning, and evolving every day. Your contributions will open doors for career advancement that are unique to our organization. Salary and Benefits: Compensation for this position typically ranges between $238,000 and $357,500. This includes base pay and potential bonuses, determined by factors such as local labor markets, education, work experience, and performance. In addition to salary, we offer a comprehensive benefits package, incentive programs, equity opportunities, and a 401k plan (subject to eligibility requirements). At UnitedHealth Group, we are driven by our mission to help people lead healthier lives and enhance the health system for everyone. We believe that everyone, regardless of race, gender, sexuality, age, location, or income, deserves the chance to live their healthiest life. We are committed to addressing health disparities and improving health outcomes, particularly for historically marginalized groups. As an Equal Employment Opportunity employer, UnitedHealth Group ensures that all qualified applicants receive consideration for employment without discrimination based on race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or veteran status, among other characteristics protected by law. All employees working remotely will be required to comply with UnitedHealth Group's Telecommuter Policy. A drug test will be required prior to employment.