Transforming Healthcare through Clinical Excellence and Collaboration
At United Healthcare, we're driven by a mission to simplify the healthcare experience, foster healthier communities, and eliminate barriers to quality care. As a leading healthcare organization, we're committed to creating a more responsive, affordable, and equitable healthcare system. If you're a dedicated and experienced Physician Assistant looking for a challenging and rewarding role, we invite you to explore this exciting opportunity to join our team as an Appeals and Grievances Physician Assistant in Cardiology.
About the Role
We're seeking a skilled and detail-oriented Physician Assistant to work collaboratively with our Appeals and Grievances Medical Directors and other healthcare professionals to review and adjudicate appeals and grievances cases related to cardiology services. As a remote role, you'll have the flexibility to work from anywhere within the United States, while making a meaningful impact on the lives of millions of people.
Key Responsibilities
- Conduct individual case reviews for appeals and grievances related to various health plan and insurance products, including PPO, ASO, HMO, MAPD, and PDP, focusing on benefit design and coverage, medical necessity, and the application of clinical criteria of medical policies.
- Collaborate with United Healthcare medical directors to discuss appeals decision rationales and benefit interpretations, ensuring consistency and accuracy in decision-making.
- Participate in team meetings to share knowledge, provide feedback, and contribute to process improvement initiatives, staff training, and program evaluation.
- Provide clinical and strategic input on organizational committees, projects, and task forces, leveraging your expertise to drive positive change.
- Work effectively as part of an integrated team, fostering a culture of collaboration and mutual respect.
Essential Qualifications
To succeed in this role, you'll need:
- A current, active, and unrestricted Physician Assistant (PA-C) license.
- Board Certification by the National Commission on Certification of Physician Assistants (NCCPA), with ongoing certification maintenance throughout your employment.
- A minimum of 5 years of clinical practice experience, with a strong background in cardiology or a related field.
- Intermediate or higher level of proficiency with managed care principles and practices.
- Excellent telephonic and interpersonal communication skills, with the ability to effectively interact with diverse stakeholders.
- Strong project management skills, with the ability to prioritize tasks and manage multiple cases simultaneously.
- Data analysis and interpretation skills, with the ability to apply data insights to inform decision-making.
- Excellent presentation skills, with the ability to communicate complex clinical information to both clinical and non-clinical audiences.
Preferred Qualifications
While not required, the following qualifications are highly desirable:
- Operating Room experience, which will be highly valued for this role.
- 2+ years of Quality Management experience, demonstrating your ability to drive quality improvement initiatives.
- Experience with claims coding and review, which will be considered a significant asset.
- Familiarity with current medical issues and practices, staying up-to-date with the latest developments in cardiology and healthcare.
What We Offer
At United Health Group, you'll have the opportunity to:
- Make a meaningful impact on the lives of millions of people, improving health outcomes and enhancing the healthcare experience.
- Collaborate with an incredible team culture, fostering a spirit of clinical and business collaboration that drives innovation and excellence.
- Develop your skills and expertise, with access to ongoing training and development opportunities that will help you grow in your role.
- Enjoy a competitive salary and benefits package, recognizing your value and contributions to our organization.
- Work in a dynamic and supportive environment, with clear direction and feedback to help you succeed.
Our Culture and Work Environment
At United Healthcare, we're committed to creating a culture that is inclusive, collaborative, and supportive. As a remote worker, you'll have the flexibility to work from anywhere within the United States, while staying connected with our team through virtual meetings and collaboration tools. We're proud of our culture and the impact it has on our employees and the communities we serve.
Compensation and Benefits
We offer a competitive salary and benefits package that recognizes your skills, experience, and contributions. While specific details may vary, we're committed to providing a comprehensive rewards package that supports your overall well-being and career goals.
Join Our Team
If you're a motivated and experienced Physician Assistant looking for a challenging and rewarding role, we encourage you to apply for this exciting opportunity. As an Appeals and Grievances Physician Assistant in Cardiology, you'll play a critical role in shaping the future of healthcare, while making a meaningful difference in the lives of our members. Apply now and let's discuss how you can become a vital part of our success story.
Ready to take the next step? We look forward to hearing from you!
Apply Now