Clinical Consultant

2 weeks ago

Cypress, United States UnitedHealth Group Full time

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.


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


Primary Responsibilities:

  • 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 UnitedHealthcare 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 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 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
  • Inpatient PA experience
  • 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 UnitedHealth Group‘s Telecommuter Policy


California, Colorado, Connecticut, Hawaii, Maryland, Nevada, New Jersey, New York, Rhode Island, Washington, Washington, D.C. Residents Only: The salary range for this role is $88,000 to $173,200 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.


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.

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.

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