Clinical Consultant Physician Assistant - Remote

UnitedHealth Group•Minnetonka, MN

5d•$91,700 - $163,700•Remote

About The Position

The Clinical Consultant Physician Assistant performs ongoing clinical review and adjudication of reconsiderations, appeals, and grievances for UnitedHealthcare associated companies. The role works in collaboration with and under the supervision of an Appeals and Grievances Medical Director, as part of an integrated team of medical director physicians, other physician associates, and appeals staff. Reviews may involve PPO, ASO, HMO, MAPD, and PDP health plan and insurance products, including adverse determinations related to benefit design and coverage, medical necessity, and application of clinical criteria and medical policies. The position communicates appeal decision rationales and benefit interpretations to UnitedHealthcare medical directors, participates in team meetings on communication, feedback, problem solving, process improvement, training, evaluation, and program results, and provides clinical and strategic input to organizational committees, projects, and task forces. The role is remote within the United States and requires adherence to UnitedHealth Group’s Telecommuter Policy. The position follows Monday–Friday normal business hours.

Requirements

Current Physician Assistant/Associate license in the state of residence.
Current board certification by the National Commission on Certification of Physician Assistants (NCCPA), maintained throughout employment.
At least 5 years of post-licensure clinical experience as a Physician Assistant.
At least 2 years of post-licensure clinical experience as a Physician Assistant in a hospital or emergency department setting.
Intermediate computer skills, including MS Office, Outlook, Word, and Excel.
Ability to work Monday–Friday during normal business hours.

Nice To Haves

At least 1 year of experience with Utilization Management and Utilization Review processes.
Experience with Appeals & Grievances.
Experience with claims coding and review.
Experience with project management.
Experience facilitating the hospital admission process.
Experience participating in the hospital inpatient admission process.
Experience conducting quality chart reviews.
Experience with hospital/inpatient medicine.
Knowledge of IPA, insurance, health plans, and managed care functions.
Demonstrated ability to work well in a team environment.

Responsibilities

Conduct ongoing clinical review and adjudication of reconsiderations, appeals, and grievances cases for UnitedHealthcare associated companies, in collaboration with and under the supervision of an Appeals and Grievances Medical Director.
Review individual appeals and grievances cases for various health plan and insurance products, including PPO, ASO, HMO, MAPD, and PDP.
Evaluate appeals concerning adverse determinations related to benefit design and coverage, medical necessity, and application of clinical criteria and medical policies.
Communicate appeal decision rationales and benefit interpretations to UnitedHealthcare medical directors.
Work as part of an integrated team of medical director physicians, other physician associates, and appeals staff.
Participate in team meetings focused on communication, feedback, problem solving, process improvement, staff training and evaluation, and sharing program results.
Provide clinical and strategic input to organizational committees, projects, and task forces.
Adhere to UnitedHealth Group’s Telecommuter Policy when working remotely.