Appeals & Grievances Physician Assistant - Cardiology - Remote
Position: Appeals & Grievances Physician Assistant - Cardiology - Remote - 2263222
Location: California
At United Healthcare, were 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.
In collaboration with and supervision by an Appeals and Grievances Medical Director, the Physician Assistant is responsible for ongoing clinical review and adjudication of appeals and grievances cases for United Healthcare associated companies.
Youll 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 assistants, 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 United Healthcare 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.
What makes your clinical career greater with United Health Group? You can improve the health of others and help heal the health care system. You can work with an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere.
Youll 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:
Physician Assistant (PA-C) with an active, unrestricted license.
Current Board Certification by National Commission on Certification of Physician Assistants (NCCPA).
Physician Assistant will maintain NCCPA certification for the length of employment.
5+ years of clinical practice experience.
Operating Room experience highly desired for current open position.
Intermediate or higher level of proficiency with managed care.
2+ years of Quality Management experience desirable.
Experience with claims coding & review a definite plus.
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.
Solid team player and team building skills.
: 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.
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Location: California
At United Healthcare, were 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.
In collaboration with and supervision by an Appeals and Grievances Medical Director, the Physician Assistant is responsible for ongoing clinical review and adjudication of appeals and grievances cases for United Healthcare associated companies.
Youll 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 assistants, 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 United Healthcare 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.
What makes your clinical career greater with United Health Group? You can improve the health of others and help heal the health care system. You can work with an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere.
Youll 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:
Physician Assistant (PA-C) with an active, unrestricted license.
Current Board Certification by National Commission on Certification of Physician Assistants (NCCPA).
Physician Assistant will maintain NCCPA certification for the length of employment.
5+ years of clinical practice experience.
Operating Room experience highly desired for current open position.
Intermediate or higher level of proficiency with managed care.
2+ years of Quality Management experience desirable.
Experience with claims coding & review a definite plus.
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.
Solid team player and team building skills.
: 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.
#J-18808-Ljbffr
Apply Now