Appeals Medical Director – General Medicine – Required – Remote

Job Summary

UnitedHealth Group is seeking an Appeals Medical Director – General Medicine to lead clinical review of appeals and grievances remotely, based in Boston, Suffolk County, MA. This senior role oversees medical policy compliance, provides expert clinical guidance, and ensures high‑quality decisions for millions of members.

Key Responsibilities

• Direct and manage the appeals and grievances process for general medicine cases, ensuring timely, accurate, and evidence‑based decisions.
• Provide clinical expertise to review complex medical documentation, interpret policy, and resolve disputes.
• Collaborate with legal, compliance, and operations teams to align decisions with regulatory requirements.
• Develop and deliver training programs for staff on medical review standards and best practices.
• Analyze appeal trends, generate actionable insights, and recommend policy improvements.
• Maintain up‑to‑date knowledge of healthcare regulations, coding standards, and clinical guidelines.
• Mentor junior medical reviewers and foster a culture of continuous improvement.

Required Qualifications

• Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO) degree with an active, unrestricted license in the United States.
• Board certification in Internal Medicine or a related specialty.
• Minimum 5 years of clinical experience, with at least 2 years in utilization review, appeals, or grievance management.
• Strong analytical skills and ability to interpret clinical data and policy.
• Excellent written and verbal communication skills.
• Proficiency with electronic health record (EHR) systems and Microsoft Office suite.

Preferred Qualifications

• Experience working in a health insurance or managed care environment.
• Familiarity with Medicare, Medicaid, and commercial payer guidelines.
• Leadership or supervisory experience.

Compensation & Benefits

Salary: $107,714.06 annually (fixed). UnitedHealth Group offers a comprehensive benefits package including medical, dental, vision, 401(k) match, paid time off, and professional development opportunities.

Location

Remote position with the candidate based in Boston, Suffolk County, MA, United States.

How to Apply

Submit your resume and cover letter through the UnitedHealth Group careers portal, referencing requisition number 2318898.

Frequently Asked Questions

What does an Appeals Medical Director do?

The Appeals Medical Director oversees clinical review of medical appeals and grievances, ensures decisions are evidence‑based, and aligns outcomes with policy and regulatory standards.

Is this position fully remote?

Yes, the role is remote but requires the candidate to reside in Boston, Suffolk County, MA.

What qualifications are required?

A valid MD or DO license, board certification in Internal Medicine, at least 5 years of clinical experience, and prior utilization review or appeals experience.