Clinical Consultant, Physician Assistant - Remote

UnitedHealth Group•Minnetonka, MN

2d•$91,700 - $163,700•Remote

About The Position

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Requirements

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

Nice To Haves

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

Responsibilities

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 (The appeals are in response to adverse determinations for medical services related to benefit design and coverage, medical necessity, and the application of clinical criteria of medical policies)
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