Prior Authorization DMEPOS Consultant – Telecommute
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In collaboration with and supervision by a Medical Director, the DMEPOS Consultant provides support to Prior Authorization operations, the organization responsible for the initial clinical review of service requests for OptumCare. The DMEPOS Consultant collaborates with OptumCare leadership and staff to establish, implement, support and maintain clinical and operational processes related to benefit coverage and medical necessity determinations. The DMEPOS Consultant’s daily activities primarily focus on the application of clinical knowledge in various utilization management activities regarding DMEPOS reviews with a focus on pre-service benefit and coverage determination or medical necessity (according to the benefit package).
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
- Work as part of an integrated team of medical director physicians, physician assistants, nurses, and other members of the OptumCare and Care Delivery 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 an OptumCare 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 medical policies and benefit document language in the process of prior authorization reviews for OptumCare and Care Delivery Organizations. Conduct daily clinical review and evaluation of all service requests collaboratively with Prior Authorization staff
- Available and accessible to OptumCare and Care Delivery Staff staff throughout the day to respond to inquiries. Serve as a clinical resource within OptumCare
- Actively participate as a member of OptumCare and Care Delivery Organization teams in regular meetings and projects focused on communication, feedback, problem solving, process improvement, staff training and evaluation and sharing of program results
- Actively participate in identifying and resolving problems and collaborates in process improvements that may be outside own team
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
- Certified as a CDME (certified Durable Medical Equipment Specialist) AND/OR an ATP (Assisted Technology Professional) credentialed Rehabilitation Engineering Society of North America with an emphasis on all DME (complex chairs, PCD, ventilators/C-PAP/BI-PAP, as well as other DME categories)
- Board Certification / Credentialing will be maintained for the length of employment
- 10+ years of hands-on clinical practice experience
- Experience with claims coding and review
- Intermediate or higher level of proficiency with managed care
- Telephonic communication skills; interpersonal communication skills
- Data analysis and interpretation skills
- Presentation skills for both clinical and non-clinical audiences
- Familiarity with current medical issues and practices
- Creative problem solving skills
- Basic computer skills, typing, word processing, presentation, and spreadsheet applications skills
- Internet researching skills
- Team player and team building skills
UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)
Colorado Residents Only: The salary range for Colorado residents is $79,700 to $142,600. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy
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: Prior Authorization DMEPOS Consultant, Orthotist, Prosthetis, Clinical Practice, Telecommute, Telecommuter, Telecommuting, Remote, Work from home, Work at home
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