Clinical Consultant - Physician Associate - Remote

UnitedHealth Group • Chicago, IL

415d • $88,000 - $173,200 • Remote

About The Position

The Clinical Consultant - Physician Associate role at UnitedHealth Group involves collaborating with a Medical Director to review and adjudicate appeals and grievances cases. This position is integral to ensuring quality care and improving health outcomes by addressing adverse determinations related to medical services. The role requires effective communication with medical directors and participation in team meetings focused on process improvement and staff training.

Requirements

• 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 during 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 processes.
• Experience with conducting quality chart reviews.
• Inpatient PA experience.
• Knowledge of IPA, insurance, health plans, and managed care functions.
• Proven ability to work well in a team environment.

Responsibilities

• Collaborate with the Appeals and Grievances Medical Director to review and adjudicate appeals and grievances cases.
• Work as part of an integrated team of medical directors, physician associates, and appeals staff.
• Perform individual case reviews for various health plan and insurance products related to adverse determinations.
• Communicate with medical directors regarding appeals decision rationales and benefit interpretations.
• Participate in team meetings focused on communication, feedback, problem solving, and process improvement.
• Provide clinical and strategic input 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