Clinical Consultant - Physician Associate - Remote

UnitedHealth Group • Houston, TX

410d • $88,000 - $173,200 • Remote

About The Position

The Clinical Consultant - Physician Associate role at UnitedHealth Group involves collaborating with a Medical Director to review and adjudicate appeals and grievances cases. This position is integral to ensuring quality care and effective communication within the healthcare system, focusing on various health plan products. The role emphasizes teamwork, clinical input, and participation in organizational initiatives to improve processes and outcomes.

Requirements

• Current Physician Assistant/Associate license in the state of residence.
• Current Board Certification by NCCPA.
• 5+ years of clinical PA practice experience.
• Intermediate computer skills in MS Office, Outlook, Word, and Excel.
• Ability to work Monday-Friday during normal business hours.

Nice To Haves

• 1+ years of experience in Utilization Management and Utilization Review processes.
• Experience with Appeals & Grievances.
• Experience with claims coding & review.
• Experience with project management.
• Experience facilitating hospital admission processes.
• Experience conducting quality chart reviews.
• Inpatient PA experience.
• Knowledge of IPA, insurance, health plans, and managed care functions.
• Proven ability to work well in a team environment.

Responsibilities

• Collaborate with the Appeals and Grievances Medical Director to review and adjudicate cases.
• Work as part of an integrated team of medical directors and physician associates.
• Perform individual case reviews for appeals and grievances related to medical services.
• Communicate with medical directors regarding appeals decision rationales and benefit interpretations.
• Participate in team meetings focused on communication, feedback, and process improvement.
• Provide clinical and strategic input in organizational committees and projects.

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Insurance Carriers and Related Activities
• Education Level: No Education Listed