Appeals & Grievances Physician Assistant - Cardiology - Remote

UnitedHealth Group • Boston, MA

382d • $88,000 - $173,200 • Remote

About The Position

The Appeals & Grievances Physician Assistant at UnitedHealth Group is responsible for the clinical review and adjudication of appeals and grievances cases related to various health plan products. This role involves collaboration with medical directors and other healthcare professionals to ensure quality care and compliance with medical policies. The position offers the flexibility to work remotely from anywhere in the U.S.

Requirements

• Physician Assistant (PA-C) with an active, unrestricted license
• Current Board Certification by National Commission on Certification of Physician Assistants (NCCPA)
• 5+ years of clinical practice experience
• Operating Room experience highly desired
• Intermediate or higher level of proficiency with managed care
• 2+ years of Quality Management experience desirable
• Experience with claims coding & review a definite plus
• Excellent telephonic communication skills
• Excellent interpersonal communication skills
• Excellent project management skills
• Data analysis and interpretation skills
• Excellent presentation skills for both clinical and non-clinical audiences
• Familiarity with current medical issues and practices
• Creative problem-solving skills
• Basic computer skills, typing, word processing, presentation, and spreadsheet applications skills
• Internet researching skills
• Solid team player and team building skills

Nice To Haves

• Experience with claims coding & review
• Operating Room experience

Responsibilities

• Work as part of an integrated team of medical director physicians, other physician assistants, and other members of the appeals staff
• Perform individual case review for appeals and grievances for various health plan and insurance products
• 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

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Insurance Carriers and Related Activities
• Education Level: No Education Listed