Pulmonary Medicine Physician General & Critical Care Pulmonologist - Physicians Only Apply - Perm
Company: UnitedHealth Group
Posted on: June 25, 2022
A Pulmonary Medicine Physician General & Critical Care
Pulmonologist practice is seeking a qualified physician for
WORCESTER, MA. This and other physician jobs brought to you by
ExactMD. Medical Doctors Only Apply.
Appeals and Grievances --- Work From Home
The Appeals and Grievances Medical Director is responsible for
ongoing clinical review and adjudication of appeals and grievances
cases for UnitedHealthcare associated companies. Performance
- 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
- Perform Department of Insurance/Department of Managed Healthcare,
and CMS regulatory responses. - Communicate with UnitedHealthcare
medical directors regarding appeals decision rationales, and
- 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.
-MD or DO with an active, unrestricted license
-Board Certified in an ABMS or AOBMS specialty
-5+ years clinical practice experience
-Intermediate or higher level of proficiency with managed care
-2+ years Quality Management experience
- 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
- Strong team player and team building skills.
Careers with UnitedHealthcare: Let's talk about opportunity. Start
with a Fortune 14 organization that's serving more than 85 million
people already and building the industry's singular reputation for
bold ideas and impeccable execution. Now, add your energy, your
passion for excellence, your near-obsession with driving change for
the better. Get the picture? UnitedHealthcare is serving employers
and individuals, states and communities, military families and
veterans where ever they're found across the globe. We bring them
the resources of an industry leader and a commitment to improve
their lives that's second to none. This is no small opportunity.
It's where you can do your life's best work.SM
Diversity creates a healthier atmosphere: All qualified applicants
will receive consideration for employment without regard to race,
color, religion, sex, national origin, protected veteran status, or
disability status. UnitedHealth Group is a drug-free workplace.
Candidates are required to pass a drug test before beginning
employment. In addition, employees in certain positions are subject
to random drug testing.
Keywords: UnitedHealth Group, Worcester , Pulmonary Medicine Physician General & Critical Care Pulmonologist - Physicians Only Apply - Perm, Other , Worcester, Massachusetts
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