Appeals and Grievances Medical Director - Otolaryngology (ENT) Specialty Required - Remote
Company: UnitedHealth Group
Location: Cypress
Posted on: April 22, 2025
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Job Description:
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:
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 of 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
The salary range for this role is $269,500 to $425,500 annually
based on full-time employment. 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.
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, or any other
characteristic protected by local, state, or federal laws, rules,
or regulations.
UnitedHealth Group is a drug - free workplace. Candidates are
required to pass a drug test before beginning employment.
Keywords: UnitedHealth Group, Santee , Appeals and Grievances Medical Director - Otolaryngology (ENT) Specialty Required - Remote, Executive , Cypress, California
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