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Part Time Clinical Appeals Consultant - Telecommute
ALIQUIPPA PA 15001
Category: Health Care Industry , Insurance
  • Your pay will be discussed at your interview

Job code: lhw-e0-89829627

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UnitedHealth Group

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  Job posted:   Fri May 18, 2018
  Distance to work:   ? miles
       
  1 Views, 0 Applications  
 
Part Time Clinical Appeals Consultant - Telecommute
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) Part Time - 3 days a week (24 hours per week) Positions in this function are responsible for providing expertise or general support in reviewing, researching, investigating, negotiating and resolving all types of appeals and grievances; Communicates with appropriate parties issues, implications and decisions; Analyzes and identifies trends for appeals and grievances.
This includes senior level positions with education / certification / licensure other than an RN, such as BSW, MSW, DDS, Chiropractor, Physical Therapist, etc. Reviews the work of others Develops innovative approaches Sought out as expert Serves as a leader / mentor Primary Responsibilities: Anticipates customer needs and proactively develops solutions to meet them Serves as a key resource on complex and / or critical issues Solves complex problems and develops innovative solutions Performs complex conceptual analyses Reviews work performed by others and provides recommendations for improvement Forecasts and plans resource requirements Authorizes deviations from standards May lead functional or segment teams or projects Provides explanations and information to others on the most complex issues Motivates and inspires other team members Receive appeal or grievance documentation and determine relevant details (e.g., what member is requesting) Review and reconsider determinations regarding whether cases should be reopened after determination has been made Make outbound calls to members and / or providers to clarify appeal or grievance information Determine whether additional appeal or grievance reviews are required (e.g., medical necessity) Determine where appeal or grievance should be reviewed/handled or route to other departments as appropriate Obtain relevant medical records to submit appeals for additional review Work with claims or provider groups to clarify determinations and ensure appropriate handling Contact and work with other internal resources to obtain and clarify information Collect and provide information to support appeal or grievance audits Research and respond to customer or regulatory inquiries and / or second level reviews Send cases to external consultant for review as appropriate Complete appeal or grievance review procedures according to relevant regulatory or contractual requirements, processes and timeframes Manage case process from start to finish Research appeal or grievance requests in multiple computer applications to obtain information that may impact review Initiate and maintain appeal or grievance review documentation in appropriate tracking systems (e.g., Careplanner, ISET, CAG Central, ETS) Create and utilize tracking databases in Excel to document additional information as necessary Leverage internal computer systems to obtain information or keep others informed about appeal or grievance status Ensure all records, data, and documentation are entered to close cases Upload medical decisions and documents related to appeals or grievances into record repository Update appeals or grievance tracking system Required Qualifications: Physician License in good standing without any restrictions Doctoral Degree Detail orientated Microsoft Office skills (Word, Excel, Outlook) Previous experience with Physician to Physician Outreach on Injured Workers UnitedHealth Group is working to create the health care system of tomorrow.
Already Fortune 6, we are totally focused on innovation and change.
We work a little harder.
We aim a little higher.
We expect more from ourselves and each other.
And at the end of the day, we're doing a lot of good.Through our family of businesses and a lot of inspired individuals, we're building a high-performance health care system that works better for more people in more ways than ever.
Now we're looking to reinforce our team with people who are decisive, brilliant - and built for speed.Come to UnitedHealth Group, and share your ideas and your passion for doing more.
We have roles that will fit your skills and knowledge.
We have diverse opportunities that will fit your dreams. 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: Clinical Appeals, Consultant, Physician outreach, Pain Management, Workers Compensation, Telecommute, Remote 19d1a8c1-2bb8-469f-a30b-81bcb550441e
*Part Time Clinical Appeals Consultant - Telecommute*
*Pennsylvania*
*767052*

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