Healthcare: Administrative Physician - Physicians Only Apply - Perm - Worcester - (Worcester, MA)

Medical Doctors Only Apply. A Administrative Physician practice is seeking a qualified physician for WORCESTER, MA. This and other physician jobs brought to you by ExactMD. 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 accountabilities include: - 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.