Make an Impact on Patient Care and Healthcare QualityAt UnitedHealthcare, our mission is to simplify the healthcare experience, create healthier communities, and remove barriers to quality care. As an Appeals Medical Director specializing in Radiology, you will play a critical role in ensuring fair, evidence-based review of member appeals while contributing to improved healthcare outcomes across the country.
Working remotely, you will collaborate with a highly experienced team of physicians, nurses, and clinical professionals dedicated to delivering consistent, high-quality clinical decision making. This role combines independent medical judgment, regulatory expertise, and meaningful collaboration with leaders throughout the organization.
Career Growth and Advancement OpportunitiesJoining the Appeals and Grievances team offers more than a rewarding clinical role. It provides a pathway for long-term professional growth within UnitedHealthcare and the broader UnitedHealth Group organization.
Medical Directors in Appeals and Grievances gain broad exposure to:
- Medicare, Commercial, and specialty benefit structures
- Complex medical necessity and coverage determinations
- Regulatory compliance and healthcare policy interpretation
- Enterprise-wide quality, clinical strategy, and operational initiatives
- Cross-functional collaboration with clinical, legal, compliance, policy, and executive leadership teams
This experience provides opportunities for advancement into a broad range of senior physician leadership positions across the organization. As a member of the Appeals and Grievances team, physicians may also participate in high-visibility projects, committees, and strategic initiatives that enhance leadership capabilities, expand organizational influence, and support ongoing professional growth.
Primary Responsibilities: - Conduct independent clinical reviews of member appeals and grievances involving Medicare and Commercial health plans, including PPO, HMO, ASO, MAPD, and PDP products
- Evaluate appeals related to adverse coverage determinations for medical services, applying evidence-based medicine, regulatory requirements, and plan benefits
- Prepare and support responses to inquiries from regulatory agencies, including the Centers for Medicare & Medicaid Services (CMS), Departments of Insurance, and Departments of Managed Health Care
- Collaborate with fellow Medical Directors regarding appeal determinations, clinical rationale, benefit interpretation, and policy application
- Participate in departmental meetings focused on quality improvement, process enhancement, clinical consistency, education, and team development
- Provide clinical expertise and strategic insights on organizational committees, projects, and enterprise initiatives 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.
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 degree with an active, unrestricted medical license
- Board Certification in an ABMS or AOBMS-recognized specialty
- Proven solid clinical judgment and ability to apply evidence-based medicine in a utilization management and appeals environment
- Proven excellent written and verbal communication skills
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
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 to $373,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
