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.

  • RN Clinical Appeal Consultant

    1 week ago

    Cypress, California, United States UnitedHealth Group Full time

    UnitedHealth Group seeks a highly skilled RN Clinical Appeal Consultant to support our Medicare appeals process. As a consultant, you will review provider post-service claims, gather clinical information from medical records, and assess coverage criteria against established Medicare guidelines.About the PositionThis role requires strong analytical and...

  • Lactation Consultant Specialist

    5 days ago

    Cypress, California, United States Houston Methodist Cypress Hospital Full time

    Job Summary:We are seeking a highly skilled Lactation Support Consultant to join our team at Houston Methodist Cypress Hospital. The successful candidate will be responsible for providing expert breastfeeding support and education to our patients, as well as developing and implementing lactation programs and resources.About the Role:This is a full-time...

  • Lactation Support Consultant

    1 month ago

    Cypress, United States Houston Methodist Cypress Hospital Full time

    At Houston Methodist, the Lactation Support Consultant position functions at the Proficient level according to Benner's model of clinical practice and is responsible for women's services patient educational needs to include breast feeding support under the general supervision of the Nurse Director. In addition to functioning as a staff nurse as needed, this...

  • Lactation Support Consultant

    2 months ago

    Cypress, United States Houston Methodist Cypress Hospital Full time

    At Houston Methodist, the Lactation Support Consultant position functions at the Proficient level according to Benner's model of clinical practice and is responsible for women's services patient educational needs to include breast feeding support under the general supervision of the Nurse Director. In addition to functioning as a staff nurse as needed, this...

  • Lactation Support Consultant

    2 months ago

    Cypress, United States Houston Methodist Cypress Hospital Full time

    At Houston Methodist, the Lactation Support Consultant position functions at the Proficient level according to Benner's model of clinical practice and is responsible for women's services patient educational needs to include breast feeding support under the general supervision of the Nurse Director. In addition to functioning as a staff nurse as needed, this...

  • Lactation Support Consultant

    4 weeks ago

    Cypress, United States Houston Methodist Cypress Hospital Full time

    At Houston Methodist, the Lactation Support Consultant position functions at the Proficient level according to Benner's model of clinical practice and is responsible for women's services patient educational needs to include breast feeding support under the general supervision of the Nurse Director. In addition to functioning as a staff nurse as needed, this...

  • Lactation Support Consultant

    2 months ago

    Cypress, United States Houston Methodist Cypress Hospital Full time

    At Houston Methodist, the Lactation Support Consultant position functions at the Proficient level according to Benner's model of clinical practice and is responsible for women's services patient educational needs to include breast feeding support under the general supervision of the Nurse Director. In addition to functioning as a staff nurse as needed, this...

  • Behavior Analyst Consultant

    4 weeks ago

    Cypress, California, United States RESTORE ABA & SPEECH THERAPY LLC Full time

    Restorative Autism ServicesAbout Restore ABA & Speech Therapy, LLC:A faith-based clinic in Cypress, TX, dedicated to providing high-quality applied behavior analysis (ABA) services to children and families. Our goal is to foster holistic growth by addressing the mind, body, and soul, while delivering individualized, evidence-based interventions that promote...

  • Clinical Care Specialist

    6 hours ago

    Cypress, Texas, United States Superior Health Consulting Full time

    Job OverviewSuperior Health Consulting is seeking a skilled Clinical Care Specialist to provide assessments for physicians and perform supplemental monitoring and optimized detection of cardiovascular, neurological, and metabolic conditions associated with adverse health events.As a Clinical Care Specialist, you will be responsible for providing the...

  • Clinical Practice Leader

    4 weeks ago

    Cypress, California, United States Houston Methodist Cypress Hospital Full time

    Houston Methodist Cypress Hospital is seeking a skilled Clinical Practice Leader to join our team.About the RoleThis position is responsible for leading and coordinating interprofessional activities focusing on clinical practice, consultation, education, and research. The successful candidate will utilize expert communication skills to serve as a care...

  • Lactation Support Consultant

    1 week ago

    Cypress, TX, United States Houston Methodist Cypress Hospital Full time

    At Houston Methodist, the Lactation Support Consultant position functions at the Proficient level according to Benner's model of clinical practice and is responsible for women's services patient educational needs to include breast feeding support under the general supervision of the Nurse Director. In addition to functioning as a staff nurse as...

  • Clinical Social Worker Associate

    4 weeks ago

    Cypress, Texas, United States Thriveworks Full time

    Thriveworks Counseling is a national private practice group with locations in 48 states, seeking individuals pursuing Texas State Licensure as a Licensed Clinical Social Worker Associate in Cypress, Texas.We believe that client accessibility, integrity, and quality care are what's most important. Our mission is to help people live happy, successful lives by...

  • Lactation Support Consultant

    5 months ago

    Cypress, TX, United States Houston Methodist Cypress Hospital Full time

    At Houston Methodist, the Lactation Support Consultant position functions at the Proficient level according to Benner's model of clinical practice and is responsible for women's services patient educational needs to include breast feeding support under the general supervision of the Nurse Director. In addition to functioning as a staff nurse as needed, this...

  • Healthcare Support Specialist

    2 days ago

    Cypress, Texas, United States Superior Health Consulting Full time

    Company OverviewSuperior Health Consulting is a leading provider of clinical testing and optimized patient assessment solutions. We are seeking a skilled Medical Assistant or Tech to join our team.

  • Lead Applied Behavior Analyst

    5 days ago

    Cypress, California, United States RESTORE ABA & SPEECH THERAPY LLC Full time

    Job OverviewRestore ABA & Speech Therapy, LLC is a faith-based clinic dedicated to providing high-quality ABA services to children and families in Cypress, TX. Our goal is to foster holistic growth by addressing the mind, body, and soul.We are seeking an experienced Lead Applied Behavior Analyst (BCaBA) to join our team as a therapist or remote consultant....

  • Board Certified Assistant Behavior Analyst

    3 months ago

    Cypress, United States RESTORE ABA & SPEECH THERAPY LLC Full time

    Job DescriptionJob DescriptionAbout Us:Restore ABA & Speech Therapy, LLC is a faith-based clinic located in Cypress, TX, dedicated to providing high-quality applied behavior analysis (ABA) services to children and families. Our goal is to foster holistic growth by addressing the mind, body, and soul, while delivering individualized, evidence-based...

  • Hospital Medicine Physician-Cypress

    6 months ago

    Cypress, United States Memorial Hermann Health System Full time

    At Memorial Hermann, we're about creating exceptional experiences for both our patients and our employees. Our goal is to provide opportunities for our diverse employee population that develop and grow careers in a team-oriented environment focused on patient care. Every employee, at every level, begins their journey at Memorial Hermann learning about the...

  • Neurology Physician Opportunity in a Thriving Outpatient Setting

    4 weeks ago

    Cypress, Texas, United States Memorial Hermann Healthcare System Full time

    About the RoleWe are seeking a Board Certified or Board Eligible Neurologist to join our dynamic team in Cypress, Texas.This is an excellent opportunity for an experienced Neurologist to provide comprehensive diagnostic consultation services to referring physicians and new patient evaluations.Key Highlights100% Outpatient Clinic with 12-15 patients per dayNo...

  • Patient Access Coordinator

    7 days ago

    Cypress, United States Retina Consultants of Texas Full time

    Overview Retina Consultants of Texas (RCTX) is seeking an Patient Access Coordinator to join our innovative team with the mission of Fighting Blindness For The World To See. This position will be responsible for providng excellent customer service and acting as the patient liaison in the fast-paced clinic environment at the Northwest Clinic. Candidates must...

  • Medical Assistant

    7 days ago

    Cypress, United States Superior Health Consulting Full time

    Medical Assistant / Tech Looking to hire in the following locations/surrounding areas: Cypress (2) , TX Responsibilities Looking for a skilled employee to provide assessments for physicians and provide supplemental monitoring and optimized detection of cardiovascular, neurological and metabolic conditions associated with a multitude of adverse health events....