Overview At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Ready to make a difference? Join us to start Caring. Connecting. Growing together.
The Clinical Consultant is responsible for ongoing clinical review and adjudication of appeals and grievances cases for UnitedHealthcare associate companies. Youll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.
Responsibilities Work as part of an integrated team of medical director physicians, other physician associates and other members of the appeals staff
Perform individual case review 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 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 taskforces
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary for this role will range from $89,900 to $160,600 annually based on full-time employment. We comply with all minimum wage laws as applicable.
Required Qualifications Current Physician Assistant/Associate license in your state of residence
Current Board certification by National Commission on Certification of Physician Assistants (NCCPA). (Physician Associate will maintain NCCPA certification for the length of employment)
5+ 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 1+ years of Utilization Management and Utilization Review processes
Experience with Appeals & Grievances
Experience with claims coding & review
Experience with project management
Experience with facilitating hospital inpatient admission process
Experience with conducting quality chart reviews
Inpatient PA experience
Knowledge of IPA, insurance, health plans and managed care functions
Proven ability to work well in a team environment
All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
UnitedHealth Group is an Equal Employment Opportunity employer and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.