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PA-C Clinical Consultant - Appeals & Grievances - PST Telecommute

Company: Optum
Location: Cypress
Posted on: November 22, 2021

Job Description:

Pathology 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)

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 and supervision by an 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
  • Perform individual case review for appeals and grievances for various healthplan 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). (Physician Assistant will maintain NCCPA certification for the length of employment)
    3+ years of clinical PA practice experience
    Intermediate computer skills: MS Office, Outlook, Word and Excel
    Ability to work Monday-Friday normal business hours

    Preferred Qualifications:

    Previous Inpatient PA experience
    1+ years of Utilization Management and Utilization Review processes
    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
    Ability to work well in a team environment

    UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.

    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)

    *All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

    Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $79,700 to $142,600. The salary range for Connecticut/Nevada residents is $87,900 to $156,900. 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

    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: grievances, appeals, work from home, telecommute, PA-C, clinical operations, UHC, UnitedHealth Care, Cypress, CA, California,

    Keyphrases: pathology jobs, pathologist jobs, molecular pathology jobs, genetic pathology jobs, clinical pathology jobs

Keywords: Optum, Cypress , PA-C Clinical Consultant - Appeals & Grievances - PST Telecommute, Healthcare , Cypress, California

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