UnitedHealth Group Physician Assistant, Appeals & Grievances in Irvine, California

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)

As a part of our continued growth, we are searching for a new Physician Assistant to join our team.

Primary Responsibilities:

  • In collaboration with the 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

  • Work as part of an integrated team of Medical Director Physicians, other Physician Assistants, and other members of the appeals staff

  • Performs individual case reviews 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

Required Qualifications:

  • Current Physician Assistant license in your state of residence

  • Current Board Certification by National Commission on Certification of Physician Assistants (NCCPA)

  • 3+ years clinical PA practice experience

  • The ability to work well in a team environment

  • Intermediate computer skills: MS Office, Outlook, Word and Excel

  • Ability to work Monday through Friday normal business hours

  • Designated private workspace

  • High Speed Cable Internet

Preferred Qualifications:

  • 1+ years of Inpatient PA experience

  • 1+ years of Utilization Management and Utilization Review processes

  • Knowledge of IPA, insurance, health plans and managed care functions

  • Experience with claims coding & review

  • Experience in project management

  • Experience facilitating hospital admission process

  • Experience participating in hospital inpatient admission process

  • Experience conducting quality chart reviews

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 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)

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

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, PA, Managed care, UM, UR, Utilization Management, appeals & grievances, telecommute, work from home, telecommuting, telecommuter