Clinical Consultant - Physician Associate

Job d:

Location:

Minnetonka, Minnesota, United States Salary: $91,700 - $163,700/year

Job Area:
Medical & Clinical Operations Company:
United Health Group At United Healthcare, 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. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring.

Connecting. Growing together.

You'll enjoy the flexibility to work remotely
* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities of Clinical Consultant Physician Associate:

In collaboration with and supervision by an Appeals and Grievances Medical Director, the Physician Associate is responsible for ongoing clinical review and adjudication of appeals and grievances cases for United Healthcare associated companies

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 to benefit design and coverage, medical necessity, and the application of clinical criteria of medical policies)
Communicate with United Healthcare 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/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 admission process

Experience with participating in hospital inpatient admission process

Experience with conducting quality chart reviews

Experience with hospital/inpatient medicine Knowledge of IPA, insurance, health plans and managed care functions

Proven ability to work well in a team environment

Leadership Priority

Skills:

Use Resources Get things done on time and on budget using available resources assigned for the tasks

Work with Others Build and maintain productive relationships with coworkers using collaborative approaches

Execute

Understand the goals and tasks assigned, producing results by fulfilling and sometimes exceeding expectations

Support and Execute Change Cooperate with and support change initiatives
* All employees working remotely will be required to adhere to United Health Group's Telecommuter Policy 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).

No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $91,700 - $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable.

At United Health Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today,…