[Hiring] Clinical Consultant @UnitedHealth Group

Role Description

In collaboration with and supervision by an Appeals and Grievances Medical Director, the Physician Associate is responsible for ongoing clinical review and adjudication of appeals and grievances cases for UnitedHealthcare associated companies.

• Work as part of an integrated team of medical director physicians, other physician associates, and other members of the appeals staff.
• Perform individual case review for appeals and grievances for various health plan and insurance products, which may include PPO, ASO, HMO, MAPD, and PDP.
• Communicate with UnitedHealthcare medical directors regarding appeals decision rationales and benefit interpretations.
• 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.

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.

Qualifications

• Current Physician Assistant/Associate license in your state of residence.
• Current Board Certification by National Commission on Certification of Physician Assistants (NCCPA).
• 5+ years of clinical PA practice experience.
• Intermediate computer skills: MS Office, Outlook, Word, and Excel.
• Ability to work Monday-Friday normal business hours.

Requirements

• 1+ years of Utilization Management and Utilization Review processes (preferred).
• Experience with Appeals & Grievances (preferred).
• Experience with claims coding & review (preferred).
• Experience with project management (preferred).
• Experience with facilitating hospital admission process (preferred).
• Experience with participating in hospital inpatient admission process (preferred).
• Experience with conducting quality chart reviews (preferred).
• Experience with hospital/inpatient medicine (preferred).
• Knowledge of IPA, insurance, health plans and managed care functions (preferred).
• Proven ability to work well in a team environment (preferred).

Benefits

• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase.
• 401k contribution (all benefits are subject to eligibility requirements).

Company Description

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.

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.