Job Description
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. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. 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.
You'll enjoy the flexibility to work remotely * 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 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
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, Work 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
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 $89,900 to $160,600 annually based on full-time employment. We comply with all minimum wage laws as applicable.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
At UnitedHealth 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, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law 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, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
Job Tags
Minimum wage, Full time, Work experience placement, Local area, Remote work, Monday to Friday,