Appeals Medical Director - Radiology (Remote)

About the role

UnitedHealthcare is hiring a Medical Director specializing in Radiology for its Appeals and Grievances team. Working remotely from anywhere in the U.S., you will ensure fair, evidence-based review of member appeals while collaborating with a team of physicians, nurses and clinical professionals. The role offers a pathway to senior physician leadership positions within UnitedHealth Group.

Key responsibilities

• Conduct independent clinical reviews of member appeals and grievances for Medicare and Commercial plans (PPO, HMO, ASO, MAPD, PDP)
• Evaluate appeals on adverse coverage determinations using evidence-based medicine, regulatory requirements and plan benefits
• Prepare and support responses to inquiries from regulators such as CMS, Departments of Insurance and Departments of Managed Health Care
• Collaborate with fellow Medical Directors on appeal determinations, clinical rationale, benefit interpretation and policy application
• Take part in departmental meetings on quality improvement, process enhancement, clinical consistency, education and team development
• Provide clinical expertise to organizational committees, projects and enterprise initiatives

Required profile

• MD or DO degree with an active, unrestricted medical license
• Board certification in an ABMS or AOBMS-recognized specialty
• Solid clinical judgment and ability to apply evidence-based medicine in a utilization management and appeals setting
• Excellent written and verbal communication skills
• Adherence to UnitedHealth Group's Telecommuter Policy

What we offer

• Salary of $248,500 to $373,000 annually for full-time employment
• Comprehensive benefits, incentive and recognition programs, and 401(k) and stock purchase options
• Remote work flexibility and professional development opportunities