Clinical Consultant, Physician Assistant - Remote

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

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 - 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

Pay and Benefits

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 to $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable.