Appeals and Grievances Medical Director - Cypress, United States - UnitedHealthcare

UnitedHealthcare

Verified Company

Cypress, United States

3 weeks ago

Posted by:

Mark Lane

beBee recruiter

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 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
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 nonclinical audiences. Familiarity with current medical issues and practices
Creative problemsolving skills
Solid team player and team building skills
All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy