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Polysomnographic Technologist - Phoenix, AZ

UnitedHealth Group


Location:
Phoenix, AZ
Date:
08/18/2017
2017-08-182017-09-16
Job Code:
1775500
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Job Details


Polysomnographic Technologist - Phoenix, AZ(Job Number:726121)
Description

Expanding access to affordable, high quality health care starts here. This is where some of the most innovative ideas in health care are created every day. This is where bold people with big ideas are writing the next chapter in health care. This is the place to do your life's best work.(sm)
 
The Polysomnographic Technologist works under the general supervision of a CCR Medical Director, and under direct supervision of a CCR Clinical Supervisor or Clinical Manager , to provide support to Clinical Coverage Review operations: the organization responsible for the initial clinical review of service requests for UnitedHealth Care (UHC). The Polysomnographic Technologist collaborates with CCR leadership and staff to establish, implement, support and maintain clinical and operational processes related to benefit coverage determinations.
 
The Polysomnographic Technologist's daily activities primarily focus on the application of clinical knowledge in various utilization management activities regarding diagnostic sleep tests and devices needed for treatment of sleep-related disorders with a focus on pre-service benefit and coverage determination or medical necessity (according to the benefit package).
 
Positions in this function require various professional clinical education, certification and clinical licensure in ancillary clinical roles such as therapist or technician i.e., other than that of physician (MD or DO) or nursing (RN or LPN), based on the specific job posting, job code and grade level. Current, unrestricted licensure in applicable state is required, depending on role and grade level, for therapists (e.g., physical or speech therapists), prosthetists/orthotists, or medical specialty technicians (e.g., sleep lab technicians). Therapists may work under the supervision of an RN or a physician, and technicians work under the supervision of a physician.
 
Primary Responsibilities:
  • Collaborates with CCR leadership and staff to establish, implement, support and maintain clinical and operational processes related to benefit coverage determinations
  • Daily activities primarily focus on the application of clinical knowledge in various utilization management activities regarding diagnostic sleep tests and devices needed for treatment of sleep-related disorders with a focus on pre-service benefit and coverage determination or medical necessity (according to the benefit package)
  • Positions are responsible for providing appropriately focused Medical Mgmt Clinical Review of the activities listed below, in support of physician activities, and in accordance with specific review protocols, based on individual member plan documents, national and proprietary coverage review guidelines, and established clinical review guidelines
  • Uses technical knowledge and related review protocols in the review of clinical information and documents as they relate to company medical policy and benefit document language
  • Under the direct oversight of physicians or RNs, may recommend clinical appropriateness of designated services
  • Works under the general supervision of a CCR Medical Director, and under direct supervision of a CCR Clinical Supervisor or Clinical Manager , to provide support to Clinical Coverage Review operations: the organization responsible for the initial clinical review of service requests for UnitedHealth Care (UHC)
  • Preservice and Retrospective coverage determinations, and / or appeals for services that have been denied
  • Moderate work experience within own function
  • Some work is completed without established procedures
  • Basic tasks are completed without review by others
  • Supervision/guidance is required for higher level tasks

Job MEDICALMGMT CLINICAL REVIEW
Primary Location US-AZ-Phoenix
Other Location 
Organization CCR/Prior Authorization/MCR
Schedule Full-time
Number of Openings 2
Apply on the Company Site

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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