[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 reconsiderations, 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.

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 post-licensure clinical experience as a Physician Assistant (PA).
• 2+ years of post-licensure clinical experience as a Physician Assistant (PA) in a hospital or emergency department setting.
• 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.
• Experience with hospital/inpatient medicine.
• Knowledge of IPA, insurance, health plans and managed care functions.
• Proven 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).

Company Description

At UnitedHealth Group, our mission is to help people live healthier lives and help make the health system work better for everyone. Together, we are shaping the future of healthcare by harnessing technology and innovation to make care simpler to navigate, more affordable and more connected for the people we serve.

• We are committed to creating an inclusive workplace where everyone feels welcomed, valued, heard and respected.
• Empowering people to bring their authentic selves to work and strengthening our collective impact through diverse talents, backgrounds, experiences and perspectives.