At UnitedHealthcare, we are dedicated to transforming the health care experience, fostering healthier communities, and eliminating barriers to quality care. The impact of your work here enhances the lives of millions. Join us in creating a health care system that is more responsive, affordable, and equitable. If you're ready to make a meaningful change, come be a part of our mission of Caring. Connecting. Growing together. This is an excellent opportunity for someone looking to work remotely from anywhere within the U.S.! The Medical Director for Appeals and Grievances will oversee the clinical review and adjudication of appeals and grievances cases for UnitedHealthcare's associated companies. Key Responsibilities: Conduct individual case evaluations for appeals and grievances across various health plans and insurance products, such as PPO, ASO, HMO, MAPD, and PDP, addressing adverse determinations related to medical services, benefit design, and clinical policy application. Respond to inquiries and regulatory requirements from the Department of Insurance, Department of Managed Healthcare, and CMS. Collaborate with UnitedHealthcare medical directors to communicate the rationale behind appeals decisions and benefit interpretations. Engage with regional and plan medical directors as well as network management staff regarding access, availability, network, and quality-related matters. Participate actively in team meetings aimed at communication, feedback, process improvement, staff training, and evaluation. Provide clinical and strategic insights for organizational committees, projects, and task forces. Why build your clinical career with UnitedHealth Group? Here, you have the opportunity to make a real difference in the health of others while helping to reshape the healthcare system. You will be part of a dynamic team culture, where collaboration between clinical and business professionals is essential, and your contributions will open doors to unique opportunities. In this role, you will be recognized and rewarded for your performance in an environment that encourages growth and provides clear guidance for success in your current and future roles. Qualifications: Qualified MD or DO with an active, unrestricted medical license. Board Certification in an ABMS or AOBMS specialty. A minimum of 5 years of clinical practice experience. At least 2 years of quality management experience. Proficient understanding of managed care principles. Basic proficiency in computer skills including typing, word processing, and spreadsheets. Outstanding telephonic and interpersonal communication skills. Strong project management, data analysis, and presentation abilities for clinical and non-clinical audiences. Creative problem-solving skills and the ability to work as a solid team player. All remote employees must adhere to UnitedHealth Group's Telecommuter Policy. The compensation for this role typically ranges from $238,000 to $357,500 and includes total cash compensation that consists of base salary and bonuses, with adjustments based on factors such as education, experience, local labor markets, as well as productivity and performance over time. Additional benefits include a comprehensive package, incentive programs, equity stock purchase options, and 401k contributions, subject to eligibility requirements. Application Deadline: This position will be open for a minimum of 2 business days or until we have identified a sufficient candidate pool. Early closure may occur due to high applicant volume. At UnitedHealth Group, our mission is to empower people to live their healthiest lives and improve the health system for everyone. We believe in equitable care, understanding that everyone deserves an opportunity for good health, regardless of race, gender, age, income, or background. We are dedicated to proactively addressing health disparities and enhancing health outcomes, which remains a priority for our organization. UnitedHealth Group is an Equal Employment Opportunity employer. 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 law. As a drug-free workplace, candidates are required to pass a drug test before beginning employment.