Appeals and Grievances Medical Director - Oncologist Required - Virtual - Remote
UnitedHealthcare
Tampa, FL
15 days ago
$269,500 - $425,500
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Job Description
Join UnitedHealthcare as a Medical Director of Appeals and Grievances, where you'll lead clinical reviews and adjudications of appeals and grievances, impacting millions. Enjoy the flexibility of remote work while collaborating with a dedicated team to improve health care quality and accessibility.
Key Responsibilities
Perform individual case review for appeals and grievances for various health plan and insurance products
Perform regulatory responses including Department of Insurance/Department of Managed Healthcare, and CMS
Communicate with UnitedHealthcare medical directors regarding appeals decision rationales and benefit interpretations
Engage with regional and plan medical directors regarding access, availability, network, and quality issues
Participate in team meetings focused on communication, feedback, problem solving, process improvement, staff training and evaluation
Provide clinical and strategic input in organizational committees, projects, and task forces
Required Qualifications
MD or DO with an active, unrestricted license
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
Basic computer skills, typing, word processing, presentation, and spreadsheet applications skills
Proven excellent telephonic communication skills
Proven 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 solid team player and team building skills
Benefits & Perks
Comprehensive benefits packageIncentive and recognition programsEquity stock purchase401k contribution