Clinical Appeals & Grievances, Physician Assistant - Telecommute
Company: UnitedHealth Group
Location: San Diego
Posted on: June 24, 2022
Job Description:
UnitedHealthcare is a company that's on the rise. We're
expanding in multiple directions, across borders and, most of all,
in the way we think. Here, innovation isn't about another gadget,
it's about transforming the health care industry. Ready to make a
difference? Make yourself at home with us and start doing your
life's best work.(sm) As a part of our continued growth, we are
searching for a new -Physician Assistant -to join our team. - - -
-You'll enjoy the flexibility to telecommute* from anywhere within
the U.S. as you take on some tough challenges. Primary
Responsibilities:
- In collaboration with the Appeals and Grievances Medical
Director, the Physician Assistant 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 Assistants, and other members of the
appeals staff
- Performs individual case reviews 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 You'll be
rewarded and recognized for your performance in an environment that
will challenge you and give you clear direction on what it takes to
succeed in your role as well as provide development for other roles
you may be interested in. Required Qualifications:
- Current Physician Assistant license in your state of
residence
- Current Board Certification by National Commission on
Certification of Physician Assistants (NCCPA)
- 3+ years of clinical PA practice experience
- Ability to work well in a team environment
- Intermediate computer skills: MS Office, Outlook, Word and
Excel -
- Ability to work Monday through Friday normal business hours
-
- Designated private workspace -
- High Speed Cable Internet - - Preferred Qualifications:
- 1+ years of Inpatient Physician Assistant experience
- 1+ years of Internal Medicine or Family Practice
experience
- 1+ years of Utilization Management and Utilization Review
experience
- Knowledge of IPA, insurance, health plans and managed care
functions
- Experience with claims coding & review
- Experience in project management
- Experience facilitating hospital admission process
- Experience participating in hospital inpatient admission
process
- Experience conducting quality chart reviews To protect the
health and safety of our workforce, patients and communities we
serve, UnitedHealth Group and its affiliate companies require all
employees to disclose COVID-19 vaccination status prior to
beginning employment. In addition, some roles and locations require
full COVID-19 vaccination, including boosters, as an essential job
function. UnitedHealth Group adheres to all federal, state and
local COVID-19 vaccination regulations as well as all client
COVID-19 vaccination requirements and will obtain the necessary
information from candidates prior to employment to ensure
compliance. Candidates must be able to perform all essential job
functions with or without reasonable accommodation. Failure to meet
the vaccination requirement may result in rescission of an
employment offer or termination of employment. Careers with
UnitedHealthcare. -Let's talk about opportunity. Start with a
Fortune 5 organization that's serving more than 85 million people
already and building the industry's singular reputation for bold
ideas and impeccable execution. Now, add your energy, your passion
for excellence, your near-obsession with driving change for the
better. Get the picture? UnitedHealthcare is serving employers and
individuals, states and communities, military families and veterans
where ever they're found across the globe. We bring them the
resources of an industry leader and a commitment to improve their
lives that's second to none. This is no small opportunity. It's
where you can do -your life's best work.(sm) Colorado, Connecticut
or Nevada Residents Only: The salary -range for Colorado residents
is $82,100 to $146,900. The salary -range for Connecticut/Nevada
residents is $90,500 to $161,600. Pay is based on several factors
including but not limited to education, work experience,
certifications, etc. In addition to your salary, UnitedHealth Group
offers benefits such as, a comprehensive benefits package,
incentive and recognition programs, equity stock purchase and 401k
contribution (all benefits are subject to eligibility
requirements). No matter where or when you begin a career with
UnitedHealth Group, you'll find a far-reaching choice of benefits
and incentives. *All Telecommuters will be required to adhere to
UnitedHealth Group's Telecommuter Policy. Diversity creates a
healthier atmosphere: UnitedHealth Group is an Equal Employment
Opportunity/Affirmative Action employer and all qualified
applicants will receive consideration for employment without regard
to race, color, religion, sex, age, national origin, protected
veteran status, disability status, sexual orientation, gender
identity or expression, marital status, genetic information, or any
other characteristic protected by law. - - - - - UnitedHealth Group
is a drug - free workplace. Candidates are required to pass a drug
test before beginning employment. - -
Keywords: UnitedHealth Group, San Diego , Clinical Appeals & Grievances, Physician Assistant - Telecommute, Healthcare , San Diego, California
Didn't find what you're looking for? Search again!
Loading more jobs...