Talent.com
Appeals M.D. - Pulmonologist Required - Remote
Appeals M.D. - Pulmonologist Required - RemoteUnitedHealth Group • Cypress, CA, United States
Appeals M.D. - Pulmonologist Required - Remote

Appeals M.D. - Pulmonologist Required - Remote

UnitedHealth Group • Cypress, CA, United States
job_description.job_card.30_days_ago
serp_jobs.job_preview.job_type
  • serp_jobs.job_card.full_time
  • serp_jobs.filters.remote
job_description.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 equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together .

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

You'll enjoy the flexibility to work remotely

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

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 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 to $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 UnitedHealth Group, 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.

    serp_jobs.job_alerts.create_a_job

    Pulmonologist • Cypress, CA, United States

    Job_description.internal_linking.related_jobs
    Travel Nurse RN - Case Management

    Travel Nurse RN - Case Management

    NuWest Travel Nursing • Orange, CA, US
    serp_jobs.job_card.full_time
    NuWest Travel Nursing is seeking a travel nurse RN Case Management for a travel nursing job in Orange, California.Job Description & Requirements. We have a new assignment for RN - Case Managemen...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    Travel Nuclear Medicine Tech - $2,431 to $2,717 per week in Orange, CA

    Travel Nuclear Medicine Tech - $2,431 to $2,717 per week in Orange, CA

    AlliedTravelCareers • Orange, CA, US
    serp_jobs.job_card.full_time
    AlliedTravelCareers is working with Prime Time Healthcare to find a qualified Nuclear Medicine Tech in Orange, California, 92856!. Now Hiring : Allied Healthcare Nuclear Medicine - Orange, CA.Contact...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Travel Nuclear Medicine Tech - $2,907 per week in Los Alamitos, CA

    Travel Nuclear Medicine Tech - $2,907 per week in Los Alamitos, CA

    Triage Staffing LLC • Los Alamitos, CA, US
    serp_jobs.job_card.full_time
    Travel Radiology : Nuclear Medicine Tech Los Alamitos.Location : Los Alamitos.Shift Details : 8H Days (7 : 00 AM-3 : 30 PM). Length : 13 WEEKS 13 weeks.Apply for specific facility details.serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Travel Nurse RN - Telemetry

    Travel Nurse RN - Telemetry

    Trustaff • Covina, CA, US
    serp_jobs.job_card.full_time
    Trustaff is seeking a travel nurse RN Telemetry for a travel nursing job in Covina, California.Job Description & Requirements. As a Telemetry RN, you'll provide care for patients who require...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_hours • serp_jobs.job_card.promoted • serp_jobs.job_card.new
    Travel Nuclear Medicine Tech - $2,482 to $2,752 per week in Los Alamitos, CA

    Travel Nuclear Medicine Tech - $2,482 to $2,752 per week in Los Alamitos, CA

    AlliedTravelNetwork • Los Alamitos, CA, US
    serp_jobs.job_card.full_time
    AlliedTravelNetwork is working with LRS Healthcare to find a qualified Nuclear Medicine Tech in Los Alamitos, California, 90720!. Ready to start your next travel adventure? LRS Healthcare offers a f...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Travel Nuclear Medicine Tech - $2,907 per week in Los Alamitos, CA

    Travel Nuclear Medicine Tech - $2,907 per week in Los Alamitos, CA

    AlliedTravelNetwork • Los Alamitos, CA, US
    serp_jobs.job_card.full_time
    AlliedTravelNetwork is working with Triage Staffing LLC to find a qualified Nuclear Medicine Tech in Los Alamitos, California, 90720!. Travel Radiology : Nuclear Medicine Tech Los Alamitos.Location : ...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Travel Nuclear Medicine Tech - $2,492 per week in Los Alamitos, CA

    Travel Nuclear Medicine Tech - $2,492 per week in Los Alamitos, CA

    Atlas MedStaff • Los Alamitos, CA, US
    serp_jobs.job_card.full_time
    Atlas Medstaff is currently seeking candidates in the Nuclear Tech (Nuclear Tech) profession for a 13 week contract in the Los Alamitos, California area. Atlas Medstaff is a premier staffing firm de...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Travel Nuclear Medicine Technologist

    Travel Nuclear Medicine Technologist

    TRS Healthcare • Los Alamitos, CA, US
    serp_jobs.job_card.full_time
    TRS Healthcare is seeking a travel Nuclear Medicine Technologist for a travel job in Los Alamitos, California.Job Description & Requirements. TRS Healthcare Job ID #1407664.Pay package is based ...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Travel Nuclear Medicine Tech - $2,699 to $2,899 per week in Los Alamitos, CA

    Travel Nuclear Medicine Tech - $2,699 to $2,899 per week in Los Alamitos, CA

    AlliedTravelNetwork • Los Alamitos, CA, US
    serp_jobs.job_card.full_time
    AlliedTravelNetwork is working with Titan Medical Group to find a qualified Nuclear Medicine Tech in Los Alamitos, California, 90720!. Travel - Nuclear Medicine Tech.Los Alamitos, CA, United States....serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Physician (MD / DO) - Gastroenterology - $450,000 to $520,000 per year in Los Alamitos, CA

    Physician (MD / DO) - Gastroenterology - $450,000 to $520,000 per year in Los Alamitos, CA

    LocumJobsOnline • Los Alamitos, CA, US
    serp_jobs.job_card.full_time
    LocumJobsOnline is working with CompHealth to find a qualified Gastroenterology MD in Los Alamitos, California, 90720!.Come practice in Los Alamitos located in the northwest section of Orange Count...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    Travel Nurse RN - Telemetry

    Travel Nurse RN - Telemetry

    Malone Healthcare - Nursing • Paramount, CA, US
    serp_jobs.job_card.full_time
    Malone Healthcare - Nursing is seeking a travel nurse RN Telemetry for a travel nursing job in Paramount, California.Job Description & Requirements. LTAC / Telemetry – Registered Nurse\n\n...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_hours • serp_jobs.job_card.promoted • serp_jobs.job_card.new
    Travel Polysomnographer

    Travel Polysomnographer

    Trustaff Allied • Orange, CA, US
    serp_jobs.job_card.full_time
    Trustaff Allied is seeking a travel Polysomnographer for a travel job in Orange, California.Job Description & Requirements. As a Polysomnographic Technologist, or Registered Sleep Tech, you'...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    Travel Nurse RN - Telemetry in Paramount, CA

    Travel Nurse RN - Telemetry in Paramount, CA

    TravelNurseSource • Paramount, CA, US
    serp_jobs.job_card.full_time
    TravelNurseSource is working with GLC Group, GLC On-The-Go to find a qualified Telemetry RN in Paramount, California, 90723!. RN Telemetry (Tele) - Paramount, CA - 1-week contract.GLC – Named Best N...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Travel Nuclear Medicine Tech - $2,482 to $2,752 per week in Los Alamitos, CA

    Travel Nuclear Medicine Tech - $2,482 to $2,752 per week in Los Alamitos, CA

    LRS Healthcare • Los Alamitos, CA, US
    serp_jobs.job_card.full_time
    Ready to start your next travel adventure? LRS Healthcare offers a full benefits package, 24 / 7 support, and a responsive, traveler-first culture. What are you waiting for? Apply today!.Valid license...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Travel Nurse RN - Telemetry - $2,021 per week in Downey, CA

    Travel Nurse RN - Telemetry - $2,021 per week in Downey, CA

    TravelNurseSource • Downey, CA, US
    serp_jobs.job_card.full_time
    TravelNurseSource is working with PRN Healthcare to find a qualified Telemetry RN in Downey, California, 90239!.Your adventure starts here with PRN Healthcare!. Take control of your career with a tr...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Travel Nuclear Medicine Tech - $2,699 to $2,899 per week in Los Alamitos, CA

    Travel Nuclear Medicine Tech - $2,699 to $2,899 per week in Los Alamitos, CA

    Titan Medical Group • Los Alamitos, CA, US
    serp_jobs.job_card.full_time
    Travel - Nuclear Medicine Tech.Los Alamitos, CA, United States.NMTCB / ARRT(N) / BCLS / BLS - American Heart Association. Nuclear Medicine Technologist - Los Alamitos, CA.Start : 12 / 01 / 2025 | ⏳ Duration : 1...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Travel Nurse RN - Telemetry - $2,030 per week in Paramount, CA

    Travel Nurse RN - Telemetry - $2,030 per week in Paramount, CA

    TravelNurseSource • Paramount, CA, US
    serp_jobs.job_card.full_time
    TravelNurseSource is working with PRN Healthcare to find a qualified Telemetry RN in Paramount, California, 90723!.Your adventure starts here with PRN Healthcare!. Take control of your career with a...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Travel Nuclear Medicine Tech - $2,749 to $2,949 per week in Los Alamitos, CA

    Travel Nuclear Medicine Tech - $2,749 to $2,949 per week in Los Alamitos, CA

    Titan Medical Group • Los Alamitos, CA, US
    serp_jobs.job_card.full_time
    Travel - Nuclear Medicine Tech.Los Alamitos, CA, United States.BCLS / BLS - American Heart Association / NMTCB / ARRT(N). Nuclear Medicine Technologist - Los Alamitos, CA ☀.Start : 12 / 01 / 2025 | ⏳ Duration : ...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted