Physician Assistant - Member Appeals & Grievances - Telecommute
Company: UnitedHealth Group
Location: Cypress
Posted on: June 21, 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)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.You'll enjoy the flexibility to telecommute* from
anywhere within the U.S. as you take on some tough
challenges.Primary Responsibilities:
- 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 health plans 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 forcesYou'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:
- Physician Assistant (PA-C) with an active, unrestricted
license
- Current Board Certification by National Commission on
Certification of Physician Assistants (NCCPA)
- Physician Assistant will maintain NCCPA certification for the
length of employment
- 5+ years of post-grad hands-on clinical practice experience in
General Surgery, ENT, Physical Medicine and/or Rehab
- Ability to work from home and the resources available to have
an office from home
- Ability to work a standard Monday through Friday business hour
work shiftPreferred Qualifications:
- 10+ years of post-grad hands-on clinical practice
experience
- Experience with managed care principles & utilization of
evidence-based clinical criteria
- Intermediate computer skills, typing, word processing,
presentation, and spreadsheet applications skills
- Internet researching skills
- Familiarity with current medical issues and practices
- Excellent telephonic communication skills; excellent
interpersonal communication skills
- Excellent project management skills
- Excellent presentation skills for both clinical and
non-clinical audiences
- Data analysis and interpretation skills
- Creative problem-solving skills
- Solid team player and team building skillsTo 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, Cypress , Physician Assistant - Member Appeals & Grievances - Telecommute, Healthcare , Cypress, California
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