Appeals Medical Director - Emergency Medicine Required - Remote

UnitedHealth Group • Chicago, IL • 6h ago

Requisition number: 2358307

Job category: Medical & Clinical Operations

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 optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together

Work 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 Responsibilities:

The 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 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

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

Familiarity with current medical issues and practices

Intermediate or higher level of proficiency with managed care

Proven excellent telephonic communication skills; excellent interpersonal communication skills

Proven excellent project management skills

Proven data analysis and interpretation skills

Proven excellent presentation skills for both clinical and non-clinical audiences

Proven creative problem-solving skills

Proven basic computer skills, typing, word processing, presentation, and spreadsheet applications skills. Internet researching skills

Proven solid team player and team building skills

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Pay 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."

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.

Similar Jobs

Health Actuary Consultant

Deloitte • Chicago, IL • 52min ago

Hospital & Medical

Join Deloitte's Human Capital practice as an Actuarial Consultant and help clients address complex challenges across the health care ecosystem. In this role, you will support strategic and technical consulting engagement...

52min ago

Go to Apply

Health Actuary Senior Consultant

Deloitte • Chicago, IL • 56min ago

Hospital & Medical

Join Deloitte's Human Capital practice and help organizations navigate complex challenges across the healthcare ecosystem. As an Actuarial Senior Consultant, you will apply actuarial, strategic, and analytical experience...

56min ago

Go to Apply

Registered Nurse - Critical Care

Veterans Affairs, Veterans Health Administration • Chicago, IL • 3h ago

Hospital & Medical

Summary This position is eligible for the Education Debt Reduction Program (EDRP), a student loan payment reimbursement program. You must meet specific eligibility requirements per VHA policy and submit your EDRP applica...

3h ago

Go to Apply

Appeals Medical Director - Remote

UnitedHealth Group • Chicago, IL • 6h ago

Hospital & Medical

Requisition number: 2351224 Job category: Medical & Clinical Operations At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The wor...

6h ago

Go to Apply

Medical File Clerk

Robert Half • Alsip, IL • 7h ago

Hospital & Medical

Description We are looking for a detail-oriented Medical File Clerk to support records management for a non-profit organization in Alsip, Illinois. This is a Contract position focused on maintaining accurate, secure, and...

7h ago

Go to Apply

EMS Patient Account Representative

Superior Ambulance Service • Elmhurst, IL • 7h ago

Hospital & Medical

Overview EMS Patient Account Representative (Spanish Bilingual - Required) The EMS Patient Account Representative is responsible for working directly with the patients and their health insurance to resolve open balances....

7h ago

Go to Apply

PRN PT-Physical Therapist

Enhance Rehabilitation • Chicago, IL • 8h ago

Hospital & Medical

Enhance Rehabilitation is currently seeking qualified Physical Therapists candidates to join our dynamic team. As an Enhance Rehabilitation Physical Therapist, you will be a part of growing team providing the highest qua...

8h ago

Go to Apply

PRN Physical Therapist Assistant

Enhance Rehabilitation • Evanston, IL • 8h ago

Hospital & Medical

Enhance Rehabilitation is currently seeking qualified physical therapy assistant candidates to join our dynamic team. As an Enhance Rehabilitation physical therapist assistant, working under the guidance of a physical th...

8h ago

Go to Apply

Operating Technician Manufacturing - Night Shift

Sherwin-Williams • Wheeling, IL • 13h ago

Hospital & Medical

This position is an essential part of Sherwin's manufacturing team. This position is responsible for setting up, running, and maintaining manufacturing equipment to produce paint and coating products consistent with cust...

13h ago

Go to Apply

$47 RN $38 LPN GTUBE,TRACHE AND VENT SCHOOL NURSE MON-FRI 7:00AM-4:00PM

Reliance Home Health Caregivers • Bensenville, IL • 17h ago

Hospital & Medical

We are Reliance Home Health Caregivers! Immediate hire $47RN/$38LPN We are urgently seeking a nurse for a 5 year old male GTUBE, TRACHEA and VENT Monday-Friday (School nurse) 7:00am-4pm. We are home health care company t...

17h ago

Go to Apply

Subscribe to get new jobs sent directly to you
(no charge, cancel anytime)