Position Description For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm)
In collaboration with and supervision by an Appeals and Grievances Medical Director, the Physician Assistant or Nurse Practitioner is responsible for ongoing clinical review and adjudication of appeals and grievances cases for UnitedHealthcare associated companies.
Work at home!
You’ll enjoy the flexibility to telecommute* 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 assistants, and other members of the MCR staff
Perform individual case review for Medical Claim Review for various health plan and insurance products, which may include PPO, ASO, HMO, MAPD, and PDP. These claims may be 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 MCR 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:
Physician Assistant unrestricted license
Must be currently board-certified by an appropriate midlevel practitioner certifying agency
5+ years post-grad hands on hospital based medicine experience
Intermediate or higher level of proficiency with managed care
Preferred Qualifications:
10+ years of post-grad hands-on clinical practice experience
Excellent telephonic communication skills; excellent interpersonal communication skills
Excellent project management skills
Data analysis and interpretation skills
Excellent presentation skills for both clinical and non-clinical audiences
Familiarity with current medical issues and practices
Creative problem solving skills
Basic computer skills, typing, word processing, presentation, and spreadsheet applications skills
Internet researching skills
Strong team player and team building skills
2+ years of Quality Management experience
Experience with claims coding & review
Experience with managed care principles & utilization of evidence-based clinical criteria
Designated quiet work space
Active secure high speed internet via cable / DSL in the home
Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.(sm)
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
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.
Job Keywords: Physician Assistant, project management, quality management, claims coding, hospital based medicine, telecommute, telecommuting, telecommuter, work from home, remote, PA-C, NCCPA, Appeals and Grievances, Case Review, , PPO, ASO, HMO, MAPD, PDP, Community & State, C&S
Job Details
Requisition Number
809893
Job Title
Hospital Based Medicine - Appeals and Grievances,
