Physician Assistant - Hospital Based Medicine - Appeals and Grievances - Telecommute - Full-time / Part-time

The qualified candidate will be available full-time Monday thru Friday.  
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)
 
Work at home!
 
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 UnitedHealthcare associated companies. 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 plans 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:

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
Minimum of 5 years of post-grad hands-on clinical practice experience
Minimum of 5 years of recent post-grad hands-on hospital based medicine experience
Intermediate or higher level of proficiency with managed care
Preferred Qualifications:

10 or more 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 desirable
Experience with claims coding & review a definite plus
Experience with managed care principles & utilization of evidence-based clinical criteria
Ability to work from home and the resources available to have an office from home
Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 14 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)
 
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