At UnitedHealthcare, we are dedicated to simplifying the health care experience and fostering healthier communities. Your work here will make a positive impact on millions of lives. Join us in building a more responsive, affordable, and equitable health care system. Ready to make a significant difference? Come and be a part of our mission: Caring. Connecting. Growing together. Enjoy the flexibility of working from home! The Medical Director of Appeals and Grievances plays a critical role in the ongoing clinical review and adjudication of cases associated with UnitedHealthcare. If you are passionate about ensuring high-quality care and improving the healthcare system, we would love to hear from you. Key Responsibilities: Conduct thorough reviews of appeals and grievances across various health plans and insurance products, including PPO, ASO, HMO, MAPD, and PDP, addressing adverse determinations for medical services. Manage responses to regulatory inquiries from state Departments of Insurance, Managed Healthcare, and CMS. Engage with UnitedHealthcare medical directors to provide clarity on appeal decisions and benefit interpretations. Collaborate with Regional medical directors and network management staff to address access, availability, network, and quality concerns. Actively participate in team meetings focused on communication, feedback, and process improvement. Offer clinical and strategic insights while serving on organizational committees and task forces. As a part of UnitedHealth Group, you have the opportunity to enhance the health of others and help transform the healthcare system. Work alongside a talented team where collaboration is key, allowing for continuous learning and professional growth. You'll be recognized for your contributions in a challenging environment that values direction and provides development opportunities for your future career. Qualifications: MD or DO with an active, unrestricted license. Board Certified in an ABMS or AOBMS recognized specialty. Over 5 years of clinical practice experience. At least 2 years of Quality Management experience. In-depth understanding of current medical issues and practices. Intermediate proficiency with managed care systems. Fundamental computer skills, including typing, word processing, and spreadsheet capabilities. Exceptional communication skills, both verbal and written. Demonstrated project management abilities. Strong skills in data analysis and interpretation. Effective presentation skills for diverse audiences. Creative problem-solving capabilities. Solid team player with team-building spirit. Please note that all remote employees must comply with UnitedHealth Group's Telecommuter Policy. The compensation for this position is competitive, generally ranging from $238,000 to $357,500, including base pay and bonuses. Total cash compensation is influenced by various factors such as local labor markets, education, and experience. In addition to salary, we offer a comprehensive benefits package and various incentive programs. Application Deadline: This position will be posted for a minimum of 2 business days or until we gather enough applicants; posting may close early due to high interest. UnitedHealth Group strives to help people lead healthier lives and make the health system work better for everyone. We champion diversity and stand against disparities in health care. Our mission includes delivering equitable care to all, mindful of our environmental impact and health equity. We are an Equal Employment Opportunity employer and welcome applicants without regard to race, nationality, religion, age, color, sex, sexual orientation, gender identity, disability, or other protected characteristics. All candidates must pass a drug test prior to employment.