Appeals and Grievances Medical Director - Cardiology Required - Remote

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. You can improve the health of others and help heal the health care system. You'll enjoy the flexibility to work remotely * from anywhere within the U.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. **2+ years Quality Management experience + Basic computer skills, typing, word processing, presentation, and spreadsheet applications skills. Proven excellent project management skills + Proven data analysis and interpretation skills + Familiarity with current medical issues and practices + Proven creative problem-solving skills + Proven 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. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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). Application Deadline:** This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. 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.