Prosthetic Certified - Medical Management Clinical Review - Telecommute Nationwide(Job Number:705854)
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In collaboration with and supervision by a CCR Medical Director, the DMEPOS Specialist provides support to Clinical Coverage Review operations, the organization responsible for the initial clinical review of service requests for UnitedHealth Care (UHC). The DMEPOS Specialist collaborates with CCR leadership and staff to establish, implement, support and maintain clinical and operational processes related to benefit coverage determinations. The DMEPOS Specialist?s daily activities primarily focus on the application of clinical knowledge in various utilization management activities regarding DME reviews with a focus on pre-service benefit and coverage determination or medical necessity (according to the benefit package).
- Work as part of an integrated team of medical director physicians, physician assistants, nurses, and other members of the CCR staff.
- 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
- Under the oversight of a CCR medical director, conduct coverage review based on individual member plan documents, and national and proprietary coverage review guidelines
- Use clinical knowledge in the application and interpretation of UHC medical policy and benefit document language in the process of clinical coverage review for UnitedHealth Care
- Conduct daily clinical review and evaluation of all service requests collaboratively with Clinical Coverage Review staff
Job MEDICALMGMT CLINICAL REVIEW
Primary Location US-NY-New York
Other Location US-TX-Houston, United States, US-GA-Atlanta, US-IL-Chicago, US-CA-Los Angeles
Organization CCR/Prior Authorization/MCR
Number of Openings 1