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Physician Assistant, Clinical Appeals & Grievances - Telecommute

Company: Optum
Location: Cypress
Posted on: April 30, 2021

Job Description:

Family Practice/Primary Care opening in Cypress, California. This and other physician assistant jobs brought to you by 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
  • The expectation is to work weekends as needed that could be an innovative/alternative scheduleYou'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 clinical PA practice experience
    • 1+ year of Post Acute Care experience
    • Orthopedic, Geriatric, Physical Medicine and Rehab experience
    • Intermediate computer skills: MS Office, Outlook, Word and Excel
    • Ability to work Monday through Friday normal business hours
    • Ability to work well in a team environment
    • 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
      • Willing to work on the weekends as needed as an innovative/alternative schedule Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 7 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 Residents Only: The salary range for Colorado residents is $79,700 to $142,600. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.*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.Job Keywords: Physician Assistant, PA, Managed care, UM, UR, Utilization Management, Appeals & Grievances, Telecommute, Work from home, Telecommuting, Telecommute, Cypress, CA, California, Seattle, WA, Washington

Keywords: Optum, Cypress , Physician Assistant, Clinical Appeals & Grievances - Telecommute, Healthcare , Cypress, California

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