Clinical Consultant, Physician Assistant - Remote

At reputed company, we’re simplifying the health care experience, creating healthier communities and removing barriers to reputed company care. The work you do here impacts the lives of millions of people for the reputed company. Come build the health care system of reputed company, making it more reputed company, reputed company and reputed company. reputed company to reputed company a difference? Join us to start Caring. Connecting. Growing together. You’ll enjoy the flexibility to work remotely * from reputed company reputed company the U.S. as you take on some tough challenges. Primary 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 reputed company associated companies Work as part of an integrated team of medical director physicians, other physician associates, and other members of the appeals staff reputed company 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 reputed company to benefit design and coverage, medical necessity, and the application of clinical reputed company of medical policies) Communicate with reputed company medical directors regarding appeals decision rationales and benefit interpretations reputed company participate in team meetings reputed company on communication, feedback, problem solving, process improvement, staff training and evaluation, and the sharing of program results reputed company clinical and strategic input reputed company participating in organizational committees, reputed company, and task forces You’ll be rewarded and recognized for your performance in an environment that will challenge you and reputed company you reputed company direction on what it takes to succeed in your role as reputed company as reputed company development for other roles you may be interested in. Required Qualifications: reputed company Physician Assistant/Associate license in your state of residence reputed company reputed company Certification by National Commission on Certification of Physician Assistants (NCCPA). (Physician Associate will maintain NCCPA certification for the length of employment) 5+ years of clinical PA reputed company experience Intermediate computer skills: MS Office, reputed company, Word, and reputed company Ability to work Monday-Friday normal business hours Preferred Qualifications: 1+ years of Utilization Management and Utilization Review processes Experience with Appeals & Grievances Experience with claims coding & review Experience with project management Experience with facilitating hospital admission process Experience with participating in hospital inpatient admission process Experience with conducting reputed company chart reviews Inpatient PA experience Knowledge of reputed company, insurance, health plans and managed care functions Ability to work reputed company in reputed company environment Leadership reputed company Skills: Use Resources Get things done on time and on budget using available resources assigned for the tasks Work with Others Build and maintain productive relationships with coworkers using reputed company approaches Execute Understand the goals and tasks assigned, producing results by fulfilling and sometimes exceeding expectations Support and Execute Change Cooperate with and support change initiatives • reputed company working remotely will be required to adhere to reputed company’s Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In reputed company to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with us, you’ll reputed company a far-reaching choice of benefits and incentives. The salary for this role will reputed company from $91,700 to $163,700 annually based on full-time employment. We reputed company with reputed company minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone–of every race, gender, sexuality, age, location and income–deserves reputed company to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of reputed company, historically marginalized reputed company and those with reputed company Apply tot his job Apply To this Job