Part -Time Appeals and Grievances Medical Director - Weekend Work - Virtual

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Part -Time Appeals and Grievances Medical Director - Weekend Work - Virtual - 712195

Position Description

Work at home!

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.

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.



Requirements

To be considered for this position, applicants need to meet the qualifications listed in this posting.

 

Qualifications:

-MD or DO with an active, unrestricted license
-Board Certified in an ABMS or AOBMS specialty
-5+ years clinical practice experience
-Intermediate or higher level of proficiency with managed care
-2+ years Quality Management experience

- 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.
- Strong team player and team building skills.


Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.SM


Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.


UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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Job Details
Contest Number: 712195
Job Title: Part -Time Appeals and Grievances Medical Director - Weekend Work - Virtual
Job Family: Medical and Clinical Operations
Business Segment: UHC Clinical Services
Job Location Information:
Region: North America
Country: United States
City: Los Angeles
State/Province: California
Other States where Job(s) is Located: AZ,TX,IL,FL,NY
Other Cities where job(s) is Located: Phoenix,Houston,Chicago,Tampa,New York
Additional Job Detail Information:
Employee Status: Regular
Schedule: Full-time
Job Level:
Shift: Day Job
Travel: No
Telecommuter Position: Yes
Overtime Status: Exempt