Physician Assistant - Pre Service Review - Home Based - Full-time / Part-time

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 Pre Service Review Clinical Coverage Review Medical Director, the Physician Assistant is responsible for ongoing clinical review and adjudication pre-service review 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 pre-service staff such as non-clinical and clinical nursing staff, and intake teams


• Perform individual case review for pre service team for various health plan and insurance products, which may include PPO, ASO, and HMO. The pre-service medical 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 post-graduate hands-on Physician Assistant clinical experience


• Oncology clinical practice experience highly desired for current open positions

Preferred Qualifications:

• Intermediate or higher level of proficiency with managed care


• 2+ years Quality Management experience desirable


• 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, emphasis on oncology


• Creative problem solving skills


• Basic PC computer skills, typing, word processing, presentation, and spreadsheet applications skills


• Internet researching skills


• Strong team player and team building skills

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: 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, PA, Home Based, Pre Service Review, Oncology, New York, NY, NYC, Chicago, IL, Illinois, Los Angeles, CA, California, Houston, TX, Texas, Philadelphia, PA, Pennsylvania, Phoenix, AZ, Arizona