Appeals and Grievances Medical Director Reconsiderations – Remote

The Appeals and Grievances Medical Director – Reconsiderations role is a remote position based out of Boston, Suffolk County, offering a competitive salary of $116,210.27. UnitedHealth Group seeks an experienced medical leader to oversee reconsideration reviews and drive quality outcomes.

Key Responsibilities

• Lead the medical directorate for appeals and grievance reconsiderations, ensuring timely, evidence‑based decisions.
• Collaborate with clinical, legal, and operations teams to develop and refine policies, protocols, and best practices.
• Perform complex medical reviews, provide clinical rationale, and mentor a team of physicians and analysts.
• Analyze data trends, identify opportunities for process improvement, and report outcomes to senior leadership.
• Ensure compliance with federal and state regulations, as well as UnitedHealth Group quality standards.

Required Qualifications

• Medical Doctor (MD or DO) degree with an active, unrestricted license in the United States.
• Minimum 5 years of clinical experience, preferably in health plan, utilization management, or claims review.
• Demonstrated expertise in appeals, grievances, or reconsideration processes.
• Strong analytical, communication, and leadership skills.
• Ability to work independently in a remote environment while maintaining collaboration across cross‑functional teams.

Preferred Experience

• Board certification in a specialty relevant to the health plan’s member population.
• Previous experience in a medical director or senior clinical operations role.
• Familiarity with healthcare data analytics tools and electronic health record systems.

Compensation & Benefits

Salary: $116,210.27 per year. UnitedHealth Group offers a comprehensive benefits package, including health, dental, vision, retirement plans, paid time off, and professional development resources.

How to Apply

Submit your resume and cover letter through the UnitedHealth Group careers portal, referencing requisition number 2349628. Join us in shaping the future of healthcare.

Frequently Asked Questions

Is this position fully remote?

Yes, the Medical Director – Reconsiderations role is remote, allowing you to work from anywhere while being based in Boston, Suffolk County.

What clinical experience is required?

At least 5 years of clinical practice, preferably in health plan operations, utilization management, or appeals and grievance review.

What is the salary for this role?

The position offers a fixed annual salary of $116,210.27.