Appeals & Grievances Physician Assistant - Cardiology - Remote
Posted 2025-04-06At United Healthcare, weÂre simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.
In collaboration with and supervision by an Appeals and Grievances Medical Director, the Physician Assistant is responsible for ongoing clinical review and adjudication of appeals and grievances cases for United Healthcare associated companies.
YouÂll enjoy the flexibility to work remotely
 from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:  Work as part of an integrated team of medical director physicians, other physician assistants, 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 United Healthcare 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
What makes your clinical career greater with United Health Group? You can improve the health of others and help heal the health care system. You can work with in an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere.
YouÂll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
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  5+ years of clinical practice experience  Operating Room experience highly desired for current open position  Intermediate or higher level of proficiency with managed care  2+ years of Quality Management experience desirable  Experience with claims coding & review a definite plus  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  Creative problem-solving skills  Basic computer skills, typing, word processing, presentation, and spreadsheet applications skills  Internet researching skills  Solid team player and team building skills  All employees working remotely will be required to adhere to United Health GroupÂs Telecommuter Policy
California, Colorado, Connecticut, Hawaii, Maryland, Nevada, New Jersey, New York, Rhode Island, Washington, or Washington, D.C. Residents Only: The salary range for this role is $88,000 to $173,200 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. United Health Group complies with al minimum wage laws as applicable. In addition to your salary, United Health Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).
No matter where or when you begin a career with United Health Group, youÂll find aÂ
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