Talent.com
Appeals M.D. - Emergency Meds - Required - Remote
Appeals M.D. - Emergency Meds - Required - RemoteUnitedHealth Group • Cypress, CA, United States
[error_messages.no_longer_accepting]
Appeals M.D. - Emergency Meds - Required - Remote

Appeals M.D. - Emergency Meds - Required - Remote

UnitedHealth Group • Cypress, CA, United States
[job_card.30_days_ago]
[job_preview.job_type]
  • [job_card.full_time]
  • [filters.remote]
[job_card.job_description]

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together

You'll enjoy the flexibility to work remotely

  • from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities :

The Appeals and Grievances Medical Director is responsible for ongoing clinical review and adjudication of appeals and grievances cases for UnitedHealthcare associated companies. Performance accountabilities include :

  • 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 UnitedHealthcare medical directors regarding appeals decision rationales, and benefit interpretations
  • Communicate with UnitedHealthcare 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
  • What makes your clinical career greater with UnitedHealth Group? You can improve the health of others and help heal the health care system. You can work with in an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere.

    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
  • Preferred Qualifications :

  • 2+ years of Quality Management experience
  • Intermediate or higher level of proficiency with managed care
  • Excellent telephonic communication skills; excellent interpersonal communication skills
  • Excellent project management skills
  • Data analysis and interpretation skills
  • Excellent presentation skills for both clinical and non-clinical audiences. Familiarity with current medical issues and practices
  • Creative problem-solving skills
  • Basic computer skills, typing, word processing, presentation, and spreadsheet applications skills. Internet researching skills
  • Solid team player and team building skills
  • All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.
  • Compensation for this specialty generally ranges from $238,000 - $357,500. Total cash compensation includes base pay and bonus and is based on several factors including but not limited to local labor markets, education, work experience and may increase over time based on productivity and performance in the role. We comply with all minimum wage laws as applicable. 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.

    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.

    At UnitedHealth 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.

    UnitedHealth 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.

    UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

    [job_alerts.create_a_job]

    Meds Required Remote • Cypress, CA, United States

    [internal_linking.related_jobs]
    Travel Nurse RN - ED - Emergency Department - $2,132 per week

    Travel Nurse RN - ED - Emergency Department - $2,132 per week

    OneStaff Medical • Fullerton, CA, USA
    [job_card.full_time]
    OneStaff Medical is seeking a travel nurse RN ED - Emergency Department for a travel nursing job in Fullerton, California. Job Description & Requirements.Emergency Nurses treat patients in emergency...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Appeals Medical Director - Oncology Required - Remote

    Appeals Medical Director - Oncology Required - Remote

    UnitedHealth Group • Cypress, CA, United States
    [filters.remote]
    [job_card.full_time]
    At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people ...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Emergency Medicine - Downey

    Emergency Medicine - Downey

    HealthEcareers - Client • Downey, CA, USA
    [job_card.full_time] +1
    Salary range for full-time / part-time openings is $.Potential premium earnings are up to $.Salaries are inclusive of incentives depending on skills and competencies and geographic location.Potential...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Travel Nurse RN - ED - Emergency Department - $1,789 per week

    Travel Nurse RN - ED - Emergency Department - $1,789 per week

    TNAA TotalMed RN • Montebello, CA, United States
    [job_card.permanent]
    TNAA TotalMed RN is seeking a travel nurse RN ED - Emergency Department for a travel nursing job in Montebello, California. Job Description & Requirements.We're looking for Emergency Room RNs for an...[show_more]
    [last_updated.last_updated_variable_hours] • [promoted]
    Travel Emergency Department RN - $2,533 per week

    Travel Emergency Department RN - $2,533 per week

    GLC On-The-Go • Arcadia, CA, United States
    [job_card.full_time]
    GLC On-The-Go is seeking a travel nurse RN ED - Emergency Department for a travel nursing job in Arcadia, California.Job Description & Requirements. Pay package is based on 12 hour shifts and 36 hou...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Emergency Medicine - Downey

    Emergency Medicine - Downey

    Kaiser Permanente – Southern California Permanente Medical Group • Downey, US
    [job_card.full_time] +1
    Salary range for full-time / part-time openings is $.Potential premium earnings are up to $.Salaries are inclusive of incentives depending on skills and competencies and geographic location.Potential...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Travel Nurse - ED - Emergency Department in Lakewood, CA - $9439 / month

    Travel Nurse - ED - Emergency Department in Lakewood, CA - $9439 / month

    Vetted Health • Lakewood, CA, United States
    [job_card.temporary]
    Job Opportunity : RN - ED - Emergency Department\n\nPosition Details\nSpecialty : RN - ED - Emergency Department\nLocation : Long Beach, California\nFacility : Fusion Medical Staffing\nEmployment Type : ...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Travel RN - ED - Emergency Department - Downey, California - $2148 / week

    Travel RN - ED - Emergency Department - Downey, California - $2148 / week

    Vetted Health • Downey, CA, United States
    [job_card.temporary]
    Job Opportunity : RN - ED - Emergency Department.Specialty : RN - ED - Emergency Department.Facility : Fusion Medical Staffing. Coordinates total nursing care for patients.Participates in patient and f...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Travel Nurse RN - ED - Emergency Department - $2,209 per week

    Travel Nurse RN - ED - Emergency Department - $2,209 per week

    Fusion Medical Staffing-Nursing • Montebello, CA, United States
    [job_card.full_time]
    Fusion Medical Staffing-Nursing is seeking a travel nurse RN ED - Emergency Department for a travel nursing job in Montebello, California. Job Description & Requirements.Facility in Montebello, Cali...[show_more]
    [last_updated.last_updated_variable_hours] • [promoted] • [new]
    Travel Nurse RN - ED - Emergency Department - $2,313 per week

    Travel Nurse RN - ED - Emergency Department - $2,313 per week

    Sharp Nursing Medical Staffing • Fullerton, CA, USA
    [job_card.full_time]
    Sharp Nursing Medical Staffing is seeking a travel nurse RN ED - Emergency Department for a travel nursing job in Fullerton, California. Job Description & Requirements.Our client is currently seekin...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Travel Nurse RN - ED - Emergency Department - $2,051 per week

    Travel Nurse RN - ED - Emergency Department - $2,051 per week

    Coast Medical Service • Fullerton, CA, USA
    [job_card.full_time]
    Coast Medical Service is seeking a travel nurse RN ED - Emergency Department for a travel nursing job in Fullerton, California. Job Description & Requirements.Coast Medical Service is a nationwide t...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Travel Nurse RN - ED - Emergency Department - $3,011 per week

    Travel Nurse RN - ED - Emergency Department - $3,011 per week

    Medical Solutions • Baldwin Park, CA, USA
    [job_card.full_time]
    Medical Solutions is seeking a travel nurse RN ED - Emergency Department for a travel nursing job in Baldwin Park, California. Job Description & Requirements.We’re seeking talented healthcare profes...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Travel Nurse - RN - MS / TELE - Medical Surgical / Telemetry - $2041 / Week - Hiring Now

    Travel Nurse - RN - MS / TELE - Medical Surgical / Telemetry - $2041 / Week - Hiring Now

    LRS Healthcare - Nursing • Santa Ana, CA, US
    [job_card.full_time]
    LRS Healthcare - Nursing is seeking an experienced Medical Surgical / Telemetry Registered Nurse for an exciting Travel Nursing job in Los Angeles, CA. Shift : Inquire Start Date : 01 / 12 / 2026 Duration : ...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Travel Nurse - ED - Emergency Department in Paramount, CA - $9439 / month

    Travel Nurse - ED - Emergency Department in Paramount, CA - $9439 / month

    VETTED • Paramount, CA, United States
    [job_card.temporary]
    Job Opportunity : RN - ED - Emergency Department\n\nPosition Details\nSpecialty : RN - ED - Emergency Department\nLocation : Long Beach, California\nFacility : Fusion Medical Staffing\nEmployment Type : ...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Travel Nurse RN - ED - Emergency Department - $1,814 per week

    Travel Nurse RN - ED - Emergency Department - $1,814 per week

    TNAA TotalMed RN • Montebello, CA, United States
    [job_card.permanent]
    TNAA TotalMed RN is seeking a travel nurse RN ED - Emergency Department for a travel nursing job in Montebello, California. Job Description & Requirements.We're looking for Emergency Room RNs for an...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Travel Nurse RN - ED - Emergency Department - $2,675 per week

    Travel Nurse RN - ED - Emergency Department - $2,675 per week

    Cross Country Nurses • Arcadia, CA, US
    [job_card.full_time]
    Cross Country Nurses is seeking a travel nurse RN ED - Emergency Department for a travel nursing job in Arcadia, California. Job Description & Requirements.As an emergency room nurse (RN ER), yo...[show_more]
    [last_updated.last_updated_variable_hours] • [promoted] • [new]
    Emergency Medicine - Downey

    Emergency Medicine - Downey

    SCPMG Meetings and Events (KPSymposia) • Downey, CA, United States
    [job_card.full_time] +1
    Competitive Compensation and Benefit Package.The comprehensive benefits and longevity-based compensation package offered by Southern California Permanente Medical Group (SCPMG) enables physicians t...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Travel Nurse - ED - Emergency Department in Downey, California - $9301 / month

    Travel Nurse - ED - Emergency Department in Downey, California - $9301 / month

    VETTED • Downey, CA, United States
    [job_card.temporary]
    Job Opportunity : RN - ED - Emergency Department\n\nPosition Details\nSpecialty : RN - ED - Emergency Department\nLocation : Downey, California\nFacility : Fusion Medical Staffing\nEmployment Type : Tem...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]