UnitedHealth Group

UnitedHealth Group is a healthcare and well-being company that’s dedicated to improving the health outcomes of millions around the world. We are comprised of

Appeals Medical Director - Dermatology

Location

United States

Posted

12 days ago

Salary

$248.5K - $373K / year

Seniority

Lead

No structured requirement data.

Job Description

Appeals Medical Director - Dermatology

UnitedHealth Group

Role Description 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 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. Qualifications - MD or DO with an active, unrestricted license - Board Certified in an ABMS or AOBMS specialty - 5+ years of clinical practice experience - 2+ years of Quality Management experience - Familiarity with current medical issues and practices - Intermediate or higher level of proficiency with managed care - Proven excellent telephonic communication skills; 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 basic computer skills, typing, word processing, presentation, and spreadsheet applications skills. Internet researching skills - Proven solid team player and team building skills Requirements - *All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy Benefits - Comprehensive benefits package - Incentive and recognition programs - Equity stock purchase - 401k contribution (all benefits are subject to eligibility requirements) Company Description 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.

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Omnicom Health logo

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