Qureos Mentor

UnitedHealthcare

<div>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:
Performance accountabilities include:<ul><li>
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</li><li>
Perform Department of Insurance/Department of Managed Healthcare, and CMS regulatory responses</li><li>
Communicate with UnitedHealthcare medical directors regarding appeals decision rationales, and benefit interpretations</li><li>
Communicate with UnitedHealthcare Regional and Plan medical directors and network management staff regarding access, availability, network, and quality issues</li><li>
Actively participate in team meetings focused on communication, feedback, problem solving, process improvement, staff training and evaluation, and the sharing of program results</li><li>
Provide clinical and strategic input when participating in organizational committees, projects, and task forces</li></ul> 
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:<ul><li>
MD or DO with an active, unrestricted license</li><li>
Board Certified in an ABMS or AOBMS specialty - No Pediatrics</li><li>
5+ years of clinical practice experience</li></ul> 
Preferred Qualifications:<ul><li>
2+ years of Quality Management experience</li><li>
Intermediate or higher level of proficiency with managed care</li><li>
Excellent telephonic communication skills; excellent interpersonal communication skills</li><li>
Excellent project management skills</li><li>
Data analysis and interpretation skills</li><li>
Excellent presentation skills for both clinical and non-clinical audiences. Familiarity with current medical issues and practices</li><li>
Creative problem-solving skills</li><li>
Basic computer skills, typing, word processing, presentation, and spreadsheet applications skills. Internet researching skills</li><li>
Solid team player and team building skills</li></ul><ul><li> 
All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy</li></ul> 
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. 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. The salary for this role will range from $238,000 to $357,500 annually based on full-time employment. We comply with all minimum wage laws as applicable. 
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.</div>

Appeals M.D. - Provider Appeals - Remote

<div>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 Healthcare Economics Analyst supports and validates Provider Network (physicians, hospitals, ancillary facilities, etc.) contracting and unit cost management activities through financial and network pricing modeling, analysis, and reporting. Healthcare Economics Analyst conducts unit cost and contract valuation analysis in support of network contracting negotiations and unit cost management strategies. Responsibilities also include managing unit cost budgets, target setting, performance reporting, and associated financial models. 
If you are able to work EST hours, you will have the flexibility to work remotely* as you take on some tough challenges. 
Primary Responsibilities:<ul><li>
Conduct financial and network pricing modeling, analysis and reporting</li><li>
Assess and interpret customer needs and requirements</li><li>
Identify solutions to non-standard requests and problems</li><li>
Solve moderately complex problems and/or conduct moderately complex analyses</li><li>
Work with minimal guidance; seek guidance on only the most complex tasks</li><li>
Translate concepts into practice</li><li>
Provide explanations and information to others on difficult issues</li><li>
Act as a resource for others with less experience</li></ul> 
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:<ul><li>
Bachelor's degree in business, economics, statistics, mathematics, or a related degree</li><li>
Demonstrated ability to interpret and review financial modeling results to evaluate the financial impact of contract changes and develop forecasts</li><li>
Intermediate level of proficiency in MS Excel and Word</li><li>
Proven solid written and verbal communication skills</li></ul> 
Preferred Qualifications:<ul><li>
Finance or related discipline internship</li><li>
Experience with provider payment methodologies and healthcare products</li><li>
Experience in healthcare field</li><li>
Intermediate level of proficiency in performing financial impact analysis, risk management and data manipulation</li></ul><ul><li> 
All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy</li></ul> 
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. 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. The salary for this role will range from $58,800 to $105,000 annually based on full-time employment. We comply with all minimum wage laws as applicable. 
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.</div>

Healthcare Economics Analyst - Remote in EST

<div>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:<ul><li>
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</li><li>
Perform Department of Insurance/Department of Managed Healthcare, and CMS regulatory responses</li><li>
Communicate with UnitedHealthcare medical directors regarding appeals decision rationales, and benefit interpretations</li><li>
Communicate with UnitedHealthcare Regional and Plan medical directors and network management staff regarding access, availability, network, and quality issues</li><li>
Actively participate in team meetings focused on communication, feedback, problem solving, process improvement, staff training and evaluation, and the sharing of program results</li><li>
Provide clinical and strategic input when participating in organizational committees, projects, and task forces</li></ul> 
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:<ul><li>
MD or DO with an active, unrestricted license</li><li>
Board Certified in an ABMS or AOBMS specialty</li><li>
5+ years clinical practice experience</li><li>
2+ years of Quality Management experience</li><li>
Intermediate or higher level of proficiency with managed care</li><li>
Basic computer skills, typing, word processing, presentation, and spreadsheet applications skills. Internet researching skills</li><li>
Proven excellent telephonic communication skills; excellent interpersonal communication skills</li><li>
Proven excellent project management skills</li><li>
Proven data analysis and interpretation skills</li><li>
Proven excellent presentation skills for both clinical and non-clinical audiences. Familiarity with current medical issues and practices</li><li>
Proven creative problem-solving skills</li><li>
Proven solid team player and team building skills</li></ul><div><ul><li> 
All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy</li></ul></div> 
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.</div>

Appeals M.D. - Gastroenterologist Required - Remote

Join UnitedHealthcare and explore 3   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.

UnitedHealthcare

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Appeals M.D. - Provider Appeals - Remote

Healthcare Economics Analyst - Remote in EST

Appeals M.D. - Gastroenterologist Required - Remote