At UnitedHealthcare, we're dedicated to transforming the health care experience, cultivating healthier communities, and eliminating barriers to quality care. The work you perform here will positively affect millions of lives. Join us to build a responsive, affordable, and equitable health care system for tomorrow. Are you ready to make an impact? Become part of our mission of Caring. Connecting. Growing together. This is a work-from-home opportunity! The Appeals and Grievances Medical Director plays a crucial role in the clinical review and adjudication process for appeals and grievances within UnitedHealthcare and its affiliated companies. You will have the flexibility to work from anywhere in the U.S. while tackling complex challenges. Primary Responsibilities: Conduct detailed reviews of individual cases concerning appeals and grievances across various health plan and insurance products, including PPO, ASO, HMO, MAPD, and PDP. These appeals typically respond to adverse determinations for medical services related to benefits design and coverage as well as the application of clinical policies. Prepare responses in accordance with Department of Insurance/Department of Managed Health Care, and CMS regulatory standards. Collaborate closely with UnitedHealthcare medical directors to discuss decision rationales related to appeals and interpret benefits. Engage with UnitedHealthcare Regional and Plan medical directors and network management staff regarding accessibility, availability, network, and quality concerns. Actively participate in team meetings aimed at enhancing communication, providing feedback, solving problems, improving processes, and sharing program results. Offer clinical and strategic insights while participating in various organizational committees, projects, and task forces. Why enhance your clinical career with UnitedHealth Group? You have the opportunity to make a meaningful difference in public health and contribute to improving the healthcare system. Work within an incredible team culture that fosters collaboration and growth every day. Your contributions will lead to numerous professional opportunities that are unique to our organization. We appreciate and recognize your performance in an environment that offers challenges and provides clear direction for success in your current role as well as opportunities for career advancement. Required Qualifications: MD or DO with an active, unrestricted medical license. Board Certified in an ABMS or AOBMS specialty. 5+ years of clinical practice experience. 2+ years of experience in Quality Management. Intermediate or advanced understanding of managed care practices. Basic computer skills, including typing, word processing, presentations, and spreadsheets. Proficient in internet research. Outstanding telephonic communication and interpersonal skills. Exceptional project management capabilities. Strong data analysis and interpretation skills. Excellent presentation skills tailored to both clinical and non-clinical audiences. Creative problem-solving abilities. Team-oriented with proven team building skills. All remote employees must comply with UnitedHealth Group's Telecommuter Policy. Compensation for this specialty typically ranges from $238,000 to $357,500. Total cash compensation will include base pay and bonuses, which reflect various factors such as local labor markets, education, work experience, and performance. We adhere to all applicable minimum wage laws. In addition to your salary, we provide comprehensive benefits, incentive programs, equity stock purchase options, and 401k contributions (all benefits are subject to eligibility requirements). Starting your career with us opens the door to a wide array of opportunities and benefits. Application Deadline: This position will remain posted for a minimum of 2 business days or until we gather a sufficient candidate pool. Posting may be removed earlier due to high application volumes. At UnitedHealth Group, our mission is to support healthier lives and improve health system functionality for everyone. We believe everyone deserves the chance to live their healthiest life, regardless of race, gender, sexuality, age, location, or income. However, many barriers to good health still exist, especially for people of color and historically marginalized groups. We are committed to mitigating our environmental impact and providing equitable care that addresses disparities and enhances health outcomes, a core priority in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law. Qualified applicants will be considered for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or veteran status, or any other characteristic protected by local, state, or federal laws. UnitedHealth Group maintains a drug-free workplace. Candidates must pass a drug test before beginning employment.