Remote Clinical Appeals & Grievances Consultant

UnitedHealth Group; Minnetonka (MN); Remote; USD 92,000 - 164,000; Full time

Benefits offered by this job

Remote work flexibility

Job summary

UnitedHealth Group's UnitedHealthcare division seeks a Clinical Consultant Physician Associate to perform ongoing clinical review and adjudication of appeals and grievances for diverse health plans and products, collaborating with medical directors and the appeals team. Remote-friendly role across the U.S.

requiring NCCPA certification, PA licensure in your state, and 5+ years of clinical experience. You will review cases, communicate rationale, participate in team meetings, and help drive

Qualifications

• Current Physician Assistant/Associate license in your state of residence.
• Current NCCPA board certification.
• 5+ years of clinical PA practice experience.
• Intermediate computer skills: MS Office, Outlook, Word, and Excel.
• Ability to work Monday–Friday normal business hours.

Responsibilities

• In collaboration with and supervision by an Appeals and Grievances Medical Director, the Physician Associate is responsible for ongoing clinical review and adjudication of appeals and grievances cases for UnitedHealthcare associated companies
• Work as part of an integrated team of medical director physicians, other physician associates, 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 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

Skills

MS Office

Outlook

Word

Excel

Tools

MS Office

Outlook

Word

Excel

Job description

UnitedHealth Group's UnitedHealthcare division seeks a Clinical Consultant Physician Associate to perform ongoing clinical review and adjudication of appeals and grievances for diverse health plans and products, collaborating with medical directors and the appeals team. Remote-friendly role across the U.S.

requiring NCCPA certification, PA licensure in your state, and 5+ years of clinical experience. You will review cases, communicate rationale, participate in team meetings, and help drive