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Optum logo
Optum

Optum, part of the UnitedHealth Group family of businesses, is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. At Optum, we support your well-being with an understanding team, extensive benefits and rewarding opportunities. By joining us, you’ll have the resources to drive system transformation while we help you take care of your future. We recognize the power of connection to drive change, improve efficiency and make a difference in health care. Join a team where your skills and ideas can make an impact and where collaboration is key to creating technology that produces healthier outcomes.

Appeals M.D. - PM&R Required - Remote

Medical DirectorMedical DirectorOtherRemoteSeniorTeam 160,000Since 2011Company Site

Location

Minnesota

Posted

79 days ago

Salary

$269.5K - $425.5K / year

Seniority

Senior

Bachelor Degree9 yrs expEnglish

Job Description

Appeals M.D. - PM&R Required - Remote

Optum

Requisition Number: 2312623 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: 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. 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 - Board Certified in an ABMS or AOBMS specialty - No Pediatrics - 5+ years of clinical practice experience Preferred Qualifications: - 2+ years of 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 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 - Solid team player and team building skills *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $269,500 to $425,500 annually based on full-time employment. We comply with all minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. 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. Candidates are required to pass a drug test before beginning employment.

Benefits

  • 401(K), Dental insurance, Disability insurance, Employee stock purchase plan, Family medical leave, Flexible Spending Account (FSA), Generous parental leave, Generous PTO, Health insurance, Job training & conferences, Life insurance, Charitable contribution matching, Paid holidays, Paid sick days, Performance bonus, Tuition reimbursement, Vision insurance, Mental health benefits, Personal development training, Bereavement leave benefits

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