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

Appeals M.D. - Pulmonologist Required - Remote

UnitedHealth GroupCypress, California, United States
job_description.job_card.variable_hours_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, California, United States

    Job_description.internal_linking.related_jobs
    • serp_jobs.job_card.promoted
    Appeals M.D. - Pulmonologist Required - Remote

    Appeals M.D. - Pulmonologist Required - Remote

    UnitedHealth GroupCypress, CA, United States
    serp_jobs.filters.remote
    serp_jobs.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 ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_1_day
    • serp_jobs.job_card.promoted
    Commercial Disputes Attorney (Healthcare)

    Commercial Disputes Attorney (Healthcare)

    Direct CounselOrange, CA, US
    serp_jobs.job_card.full_time
    Direct Counsel is representing an Am Law 100 firm in its search for a talented and dedicated midlevel associate to join the Commercial Disputes practice in its dynamic Orange County office.The idea...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Dermatology Physician Opening

    Dermatology Physician Opening

    HealthEcareers - ClientMontclair, CA, USA
    serp_jobs.job_card.full_time
    Location : Glendora / Montclair, California (Greater Los Angeles Area) .Golden State Dermatology (GSD) is led and majority owned by physicians. we have assembled a team of renowned experts committed...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Locum Physician (MD / DO) - Family Practice in Long Beach, CA

    Locum Physician (MD / DO) - Family Practice in Long Beach, CA

    LocumJobsOnlineLong Beach, CA, US
    serp_jobs.job_card.full_time +1
    LocumJobsOnline is working with Rhino Medical to find a qualified Family Practice MD in Long Beach, California, 90808!.Long Beach, CA Family Medicine Physician Locum Tenens.Rhino Medical is leading...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    A Facility in California Is Seeking a Locums Nephrologist

    A Facility in California Is Seeking a Locums Nephrologist

    HealthEcareers - ClientCarson, California, United States
    serp_jobs.job_card.full_time +1
    Interested in this assignment? Or maybe you still have not found what you are looking for? Contact one of our specialty-specific recruiters to get access to our vast network of open jobs, including...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    RN Appeals Nurse Consultant

    RN Appeals Nurse Consultant

    VirtualVocationsMission Viejo, California, United States
    serp_jobs.job_card.full_time
    A company is looking for an Appeals Nurse Consultant.Key Responsibilities Process medical necessity appeals for Medicare Part C from members and providers Collaborate with internal and external ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    California Licensed Pulmonologist

    California Licensed Pulmonologist

    VirtualVocationsGarden Grove, California, United States
    serp_jobs.job_card.full_time
    A company is looking for an Appeals M.Pulmonologist to manage clinical reviews and adjudications of appeals and grievances cases. Key Responsibilities Conduct individual case reviews for appeals a...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_1_day
    • serp_jobs.job_card.promoted
    Obstetrics and Gynecology Physician (Providence St. Joseph Hospital - Orange)

    Obstetrics and Gynecology Physician (Providence St. Joseph Hospital - Orange)

    ProvidenceOrange, US
    serp_jobs.job_card.full_time
    Joseph Heritage Medical group is seeking a full-time board-certified / board-eligible OB / Gyn physician to join a well-established team. You will work alongside experienced physicians and have a call s...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Internal Medicine

    Internal Medicine

    Steele Healthcare SolutionsDowney, California, US
    serp_jobs.job_card.full_time
    Internal Medicine physician job in California : .Post Acute Physician - Skilled Nursing Facility Physician.Make a lasting impact on patients' lives in post-acute care. With nearly 30 years of experie...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Compact State Licensed Triage Clinician

    Compact State Licensed Triage Clinician

    VirtualVocationsCorona, California, United States
    serp_jobs.job_card.full_time
    A company is looking for a Triage Clinician.Key Responsibilities Make safe decisions for appropriate care using critical thinking skills Use departmental evidence-based protocols to triage patie...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Tennessee Licensed Physician

    Tennessee Licensed Physician

    VirtualVocationsGarden Grove, California, United States
    serp_jobs.job_card.part_time
    A company is looking for a Physician - Virtual Urgent Care (Part-time).Key Responsibilities Provide high-quality care for patients in a virtual setting Collaborate with care team members on comp...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Associate Consultant, Medical Affairs

    Associate Consultant, Medical Affairs

    VirtualVocationsCarson, California, United States
    serp_jobs.job_card.full_time
    A company is looking for an Associate Consultant, Pharmaceutical Strategy.Key Responsibilities Support the implementation of multiple projects from initiation to delivery Conduct research and tr...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_1_day
    • serp_jobs.job_card.promoted
    Telemedicine Diagnostic Radiology Physician

    Telemedicine Diagnostic Radiology Physician

    AMN HealthcareWhittier, US
    serp_jobs.job_card.full_time
    Job Description & Requirements.Telemedicine Diagnostic Radiology Physician.StartDate : ASAP Available Shifts : Weekend Evening 8. Weekend Pay Rate : $291.This facility is seeking a Telemedicine Diagnos...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Hospitalist

    Hospitalist

    HealthEcareers - ClientLong Beach, California, United States
    serp_jobs.job_card.full_time
    Adventist Health White Memorial is seeking a dedicated Hospitalist to join our Internal Medicine residency program.The ideal candidate will be passionate about providing comprehensive, patient-cent...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Physician (MD / DO) - Gastroenterology - $550,000 per year in Corona, CA

    Physician (MD / DO) - Gastroenterology - $550,000 per year in Corona, CA

    LocumJobsOnlineCorona, CA, US
    serp_jobs.job_card.full_time +1
    LocumJobsOnline is working with CompHealth to find a qualified Gastroenterology MD in Corona, California, 92881!.Corona is a city in Riverside County, California, approximately 45 miles southeast o...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Locum Physician (MD / DO) - Family Practice in Pomona, CA

    Locum Physician (MD / DO) - Family Practice in Pomona, CA

    LocumJobsOnlinePomona, CA, US
    serp_jobs.job_card.full_time +2
    LocumJobsOnline is working with Weatherby Healthcare to find a qualified Family Practice MD in Pomona, California, 91767!. Interested? Give Weatherby a call today and speak with one of our specialty...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Internal Medicine Physician Opening in Anaheim, CA; Outpatient Setting with No Call

    Internal Medicine Physician Opening in Anaheim, CA; Outpatient Setting with No Call

    HealthEcareers - ClientAnaheim, CA, USA
    serp_jobs.job_card.full_time
    As a city built on imagination, Anaheim is where all inner-child enthusiasts can have their day.Visit Anaheim and discover an atmosphere where hip hangouts and hidden gems inspire animated attitude...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Health Care Litigation Associate Attorney

    Health Care Litigation Associate Attorney

    Crowell & MoringIrvine, CA, US
    serp_jobs.job_card.full_time
    Crowell & Moring LLP is an international law firm with offices in the United States, Europe, MENA, and Asia that represents clients in litigation and arbitration, regulatory and policy, intelle...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    • serp_jobs.job_card.new
    Senior Dosimetrist - El Segundo

    Senior Dosimetrist - El Segundo

    UCLA HealthEl Segundo, CA, US
    serp_jobs.job_card.full_time
    The Department of Radiation Oncology at UCLA is seeking a skilled and motivated Medical Dosimetrist to join our dynamic team of medical physicists and Dosimetrists. Our department is committed to de...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours
    • serp_jobs.job_card.promoted
    A Nephrologist Is Needed for Locum Tenens Coverage in California

    A Nephrologist Is Needed for Locum Tenens Coverage in California

    HealthEcareers - ClientLong Beach, California, United States
    serp_jobs.job_card.full_time
    Interested in this assignment? Or maybe you still haven't found what you're looking for? Contact one of our specialty-specific recruiters to get access to our vast network of open jobs - including ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30