Employer Industry: Healthcare Services

Why consider this job opportunity:
- Salary range of $88,000 to $173,200 annually
- Comprehensive benefits package, including equity stock purchase and 401k contributions
- Opportunity for career advancement and growth within the organization
- Work remotely from anywhere within the U.S.
- Supportive and collaborative team culture
- Chance to make a positive impact on health care and patient outcomes

What to Expect (Job Responsibilities):
- Collaborate with an integrated team of medical director physicians and appeals staff to review appeals and grievances
- Perform individual case reviews for various health plan and insurance products, addressing adverse determinations
- Communicate with medical directors regarding appeals decision rationales and benefit interpretations
- Actively participate in team meetings focused on communication, feedback, and process improvement
- Provide clinical and strategic input for organizational committees and projects

What is Required (Qualifications):
- Physician Assistant (PA-C) with an active, unrestricted license
- Current Board Certification by the National Commission on Certification of Physician Assistants (NCCPA)
- Minimum of 5 years of clinical practice experience
- At least 2 years of Quality Management experience
- Operating Room experience required

How to Stand Out (Preferred Qualifications):
- Experience with claims coding and review
- Intermediate proficiency with managed care
- Proven excellent telephonic and interpersonal communication skills
- Proven data analysis and interpretation skills
- Familiarity with current medical issues and practices

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