[Hiring] Clinical Consultant, Physician Assistant @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.
• Experience with Appeals & Grievances.
• Experience with claims coding & review.
• Experience with project management.
• Experience with facilitating hospital admission process.
• Experience with participating in hospital inpatient admission process.
• Experience with conducting quality chart reviews.
• Inpatient PA experience.
• Knowledge of IPA, insurance, health plans and managed care functions.
• Ability to work well in a team environment.

Benefits

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

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.