Talent.com
Appeals M.D. - Gastroenterologist Required - Remote

Appeals M.D. - Gastroenterologist Required - Remote

UnitedHealth GroupCypress, California, United States
30+ days ago
Job type
  • Full-time
  • Remote
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.

Work at home!

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 clinical practice experience
  • 2+ years of Quality Management experience
  • Intermediate or higher level of proficiency with managed care
  • Basic computer skills, typing, word processing, presentation, and spreadsheet applications skills. Internet researching skills
  • 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. Familiarity with current medical issues and practices
  • Proven creative problem-solving skills
  • Proven 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.

    Create a job alert for this search

    Gastroenterologist • Cypress, California, United States

    Related jobs
    • Promoted
    • New!
    Gastroenterologist (Advanced Endoscopy) Opportunities in Southern CA

    Gastroenterologist (Advanced Endoscopy) Opportunities in Southern CA

    Kaiser Permanente – Southern California Permanente Medical GroupLos Angeles, US
    Full-time +1
    Salary range includes incentives that are contingent upon skills, competencies, longevity, experience and geographic location. The earnings included in the salary range are contingent upon requisite...Show moreLast updated: 12 hours ago
    • Promoted
    Appeals M.D. - Pulmonologist Required - Remote

    Appeals M.D. - Pulmonologist Required - Remote

    UnitedHealth GroupCypress, CA, United States
    Remote
    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 moreLast updated: 28 days ago
    • Promoted
    Gastroenterology

    Gastroenterology

    Provider Solutions & DevelopmentTorrance, California, US
    Full-time
    Gastroenterology physician job in California : .Providence Medical Associates is seeking a full-time board-certified / board-eligible Gastroenterologist to join its expanding practice in Torrance, Cal...Show moreLast updated: 30+ days ago
    • Promoted
    • New!
    Gastroenterologist (Advanced Endoscopy) Opportunities in Southern CA

    Gastroenterologist (Advanced Endoscopy) Opportunities in Southern CA

    HealthEcareers - ClientRedondo Beach, California, United States
    Full-time +1
    Salary range includes incentives that are contingent upon skills, competencies, longevity, experience and geographic location. The earnings included in the salary range are contingent upon requisite...Show moreLast updated: 5 hours ago
    • Promoted
    Gastroenterologist – University of Southern California (USC), Henry Mayo Newhall Hospital

    Gastroenterologist – University of Southern California (USC), Henry Mayo Newhall Hospital

    HealthEcareers - ClientEl Segundo, California, United States
    Full-time
    The Henry Mayo Newhall Hospital, in conjunction with the Keck School of Medicine of USC, a world-renowned academic medical center in Los Angeles, is seeking a General Gastroenterologist to join our...Show moreLast updated: 23 days ago
    • Promoted
    Appeals M.D. - Gastroenterologist Required - Remote

    Appeals M.D. - Gastroenterologist Required - Remote

    UnitedHealth GroupCypress, CA, United States
    Remote
    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 moreLast updated: 30+ days ago
    • Promoted
    Gastroenterology

    Gastroenterology

    California Physician OpportunitiesLos Angeles, California, US
    Full-time
    Gastroenterology physician job in California : .Downtown Los Angeles - Gastroenterology Group.Minutes to the famous Staples Center home of the world champion NHL Kings and NBA Lakers and Clippers.Li...Show moreLast updated: 30+ days ago
    • Promoted
    Gastroenterologist Opportunity in Los Angeles | $700K+ Earnings & Path to Partnership

    Gastroenterologist Opportunity in Los Angeles | $700K+ Earnings & Path to Partnership

    Pacific CompaniesLos Angeles, CA, US
    Full-time
    Pacific Companies is excited to present an exceptional opportunity for a Gastroenterologist to join a thriving practice in downtown Los Angeles. This position offers the perfect balance of working i...Show moreLast updated: 30+ days ago
    • Promoted
    Gastroenterology

    Gastroenterology

    HealthEcareers - ClientTorrance, CA, USA
    Permanent
    Are you a gastroenterology physician searching for your next exciting locum tenens opportunity? This position with one of VISTA's healthcare partners in sunny California might just be the opportuni...Show moreLast updated: 30+ days ago
    • Promoted
    Gastroenterology

    Gastroenterology

    VISTA Staffing SolutionsTorrance, CA, US
    Permanent
    Are you a gastroenterology physician searching for your next exciting locum tenens opportunity? This position with one of VISTA's healthcare partners in sunny California might just be the opportuni...Show moreLast updated: 4 days ago
    • Promoted
    Gastroenterologist – University of Southern California (USC), Henry Mayo Newhall Hospital

    Gastroenterologist – University of Southern California (USC), Henry Mayo Newhall Hospital

    USC Keck School of MedicineLos Angeles, US
    Full-time
    The Henry Mayo Newhall Hospital, in conjunction with the Keck School of Medicine of USC, a world-renowned academic medical center in Los Angeles, is seeking a General Gastroenterologist to join our...Show moreLast updated: 24 days ago
    • Promoted
    Gastroenterologist - Southern California- Partnership Track

    Gastroenterologist - Southern California- Partnership Track

    AMN HealthcarePOMONA, CA, US
    Full-time
    Job Description & Requirements.Gastroenterologist - Southern California- Partnership Track.StartDate : ASAP Pay Rate : $650000. An established private gastroenterology practice in Southern California ...Show moreLast updated: 5 days ago
    • Promoted
    Gastroenterology

    Gastroenterology

    Enterprise Medical RecruitingLos Angeles, California, US
    Full-time
    Gastroenterology physician employment in California : .Enterprise Medical Recruiting is assisting a private practice in Los Angeles to recruit a new Gastroenterologist! The team currently has five p...Show moreLast updated: 30+ days ago
    • Promoted
    Gastroenterologist (Providence Medical Associates)

    Gastroenterologist (Providence Medical Associates)

    ProvidenceTorrance, US
    Full-time
    Providence Medical Associates is seeking a full-time board-certified / board-eligible Gastroenterologist to join its expanding practice in Torrance, California. As part of our team, you will experienc...Show moreLast updated: 30+ days ago
    • Promoted
    Appeals Medical Director - Oncology Required - Remote

    Appeals Medical Director - Oncology Required - Remote

    UnitedHealth GroupCypress, CA, United States
    Remote
    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 moreLast updated: 30+ days ago
    • Promoted
    Gastroenterologist Opportunity with Kaiser Permanente in Southern CA

    Gastroenterologist Opportunity with Kaiser Permanente in Southern CA

    Kaiser Permanente – Southern California Permanente Medical GroupLos Angeles, US
    Full-time +1
    Salary range for full-time / part-time openings is $510,775.Potential premium earnings are up to $56,160.Salaries are inclusive of incentives depending on skills and competencies and geographic locat...Show moreLast updated: 30+ days ago
    • Promoted
    • New!
    Appeals Medical Director - General Medicine - Required - Remote

    Appeals Medical Director - General Medicine - Required - Remote

    UnitedHealth GroupCypress, CA, United States
    Remote
    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 moreLast updated: 16 hours ago
    • Promoted
    Gastroenterologist Opportunities in Southern CA

    Gastroenterologist Opportunities in Southern CA

    Kaiser Permanente – Southern California Permanente Medical GroupLos Angeles, CA, US
    Full-time +1
    Salary range for full-time / part-time openings is $510,775.Potential premium earnings are up to $56,160.Salaries are inclusive of incentives depending on skills and competencies and geographic locat...Show moreLast updated: 3 days ago