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