University of Utah Health Care

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Health Plan Medical Policy/Technology Assessment Specialist

Health Plan Medical Policy/Technology Assessment Specialist

Requisition Number 
27907
Reg/Temp 
Regular
Employment Type 
Full-Time
Shift 
Day
Work Schedule 
8-5
Location Name 
University of Utah Health Plans
Patient Care? 
No
City 
Murray
State 
UT
Department 
UIP ENT 01H EMPLOYEE PLAN
Category 
Insurance / Health Plans

More information about this job

Overview

As a patient-focused organization, the University of Utah Health Care exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health Care seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, diversity, integrity, quality and trust that are integral to our mission. EO/AA

The role of this position is to provide support to the health plan in creating and maintaining policies used in clinical review process along with assistance in researching new technologies presented to the plan for reimbursement consideration. This individual will also be responsible in managing and performing the process used to assure all policies used in medical necessity determinations remain compliant with NCQA requirements.

This individual will be supervised by the Associate Chief Medical Officer.

Responsibilities

  • Researches evidence and background materials for creation of new administrative and medical policies used by clinical operations in performing clinical review function
  • Performs the policy review process under the supervision of the Associate chief Medical officer to assure compliance with NCQA requirements for policies used in medical necessity determinations
  • Assists in writing and drafting medical and administrative policies
  • Performs specific internet research to assist in determining appropriate coverage of newly approved medical technologies including laboratory tests, medical devices or other services. This research may include identification of specialty society positions, identification of regulatory findings specific to technologies, identification of coding specific technology, and assists in determining costs related to new and existing policies.
  • Assists in the formatting and completion of technology assessment and summary documents.
  • Maintains policies and certain technology assessment libraries and sections of the Uinversity of Utah Health Plan web site.
  • Coordinates communication outcomes of technology assessments to other interested and appropriate departments.
  • Assists in timely accurate completion of internal documentation related to technology assessments.
  • Assists in researching and updating records of all technology assessment decisions and activity, including satisfaction of additional requirements (eg, NCQA). Assists in maintaining NCQA compliance for new technology evaluations.
  • Coordinates communication of policy decisions to variety of providers.
  • Assists with secondary research in the application of principles of evidence-based medicine to the international body of biomedical literature. The primary focus of this research is new or emerging health care interventions/technologies (procedures, devices, “biologics”), but may also include established technologies.
  • Assists in the summarization and presentation of evidence to the group responsible for technology assessment for recommendation.

Knowledge / Skills / Abilities

  • Demonstrated potential ability to perform the essential functions as outlined above.
  • Demonstrated human relations and effective communications skills.
  • Demonstrated proficiency in Excel and Word.
  • Demonstrated in internet database researching skills.

Qualifications

Qualifications

Required

  • Three years clinical coding experience or certification as a professional clinical coder.
  • Demonstrated intermediate skills in internet database searches.

Qualifications (Preferred)

Preferred

  • Bachelor's degree in a clinical science (e.g. nursing, medical technology), or health related field.
  • Certified professional coder.

Working Conditions and Physical Demands

Employee must be able to meet the following requirements with or without an accommodation.

  • This is a position that may exert up to 10 pounds and may lift, carry, push, pull or otherwise move objects. This position may involve standing or sitting for long periods of time and is not exposed to adverse environmental conditions.

We are University of Utah Health. healthcare.utah.edu

Physical Requirements

Standing, Walking