Appeals Medical Director - OB GYN Required - MST or PST Preferred - Virtual
UnitedHealthcare
Phoenix, AZ
1 day ago
$238,000 - $357,500
Job Description
Join UnitedHealthcare as an Appeals Medical Director, where you will lead clinical reviews and adjudication of appeals, making a significant impact on healthcare quality and access. Enjoy the flexibility of remote work while collaborating with a dedicated team to improve health outcomes.
Key Responsibilities
Perform individual case review for appeals and grievances
Perform regulatory responses for Department of Insurance/Department of Managed Healthcare, and CMS
Communicate with medical directors regarding appeals decision rationales
Communicate with regional and plan medical directors regarding access and quality issues
Participate in team meetings for communication and process improvement
Provide clinical and strategic input in organizational committees and projects
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
Proven excellent telephonic communication skills
Proven excellent project management skills
Proven data analysis and interpretation skills
Proven excellent presentation skills
Proven creative problem-solving skills
Proven basic computer skills
Benefits & Perks
Comprehensive benefits packageIncentive and recognition programsEquity stock purchase401k contribution