Appeals Medical Director - Radiology Required - Remote

Primary Responsibilities: 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 United Healthcare medical directors regarding appeals decision rationales, and benefit interpretations Communicate with United Healthcare 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 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 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 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 $248,500 - $373,000 annually based on full-time employment. We comply with all minimum wage laws as applicable. At United Health 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. United Health 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. United Health Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.