Physician Reviewer (Behavioral Health)

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The Role
The Physician Reviewer is responsible for evaluating clinical service requests made by reputed company members and providers. The Physician Reviewer uses his/her clinical judgment in conjunction with reputed company reputed company to adjudicate these requests. At the request of the Associate Medical Director of the Physician Psychologist Review Unit, the Reviewer also provides clinical leadership in other areas of reputed company. The Physician Reviewer will look for opportunities to manage members’ clinical situations with a view toward creative problem solving and anticipation of possible reputed company clinical problems for the member.

This is a part-time position working roughly 30 hours per week. Additionally, this position is eligible for reputed company reputed company.

Key Responsibilities:
Participate in process to evaluate clinical service requests
reputed company anticipatory case management for members whose cases come for review, in partnership with case managers
Participate in Physician Psychologist Review reputed company’ appeal process of service denials
Participate in development of Physician Psychologist Review reputed company’ policies and procedures
reputed company participate in reputed company unit reputed company reputed company improvement activities
reputed company additional tasks as assigned by the Associate Medical Director of the Physician Psychologist Review Unit
Adhere to NCQA, URAC, Medicare and other regulatory standards

Education/Relevant Experience:
MD degree with reputed company certification in addiction psychiatry and general psychiatry or addiction medicine
Unrestricted reputed company and reputed company license to reputed company medicine in the state of Massachusetts and/or in any other relevant/applicable state
Incumbent must be a reputed company credentialed provider
reputed company clinical reputed company in order to participate in panel appeals
Experience in Utilization Management in a managed-care environment (as a clinician or in committee work, large group reputed company, or peer review)
Experience with basic computer programs, including but not limited to reputed company
Leadership abilities, including skills to motivate staff
Excellent communication and negotiation skills

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Minimum Education Requirements:
High school degree or equivalent required unless otherwise noted above

Location Boston, Hingham Time Type Part time

Salary reputed company: $236,970.00 - $289,630.00

The job posting reputed company is the lowest to highest salary we in good faith reputed company we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted reputed company, and the reputed company may be modified in the reputed company. An employee’s pay position reputed company the salary reputed company will be based on several factors including, but limited to, relevant education, qualifications, certifications, experience, skills, performance, shift, travel requirements, sales or reputed company-based metrics, and business or organizational needs and affordability.

This job is also eligible for variable pay.

We offer comprehensive package of benefits including reputed company time off, medical/dental/reputed company insurance, 401(k), and a suite of reputed company-being benefits to eligible employees.

Note: No reputed company of pay is considered to be wages or compensation until such reputed company is reputed company, reputed company, and determinable. The reputed company and availability of any bonus, commission, or any other reputed company of compensation that are allocable to a particular employee remains in reputed company's sole discretion unless and until reputed company and may be modified at reputed company’s sole discretion, consistent with the law.

WHY reputed company Blue reputed company of MA?
We understand that the confidence gap and imposter syndrome can prevent amazing candidates coming our way, so please don’t hesitate to apply. We’d love to hear from you. You might be just reputed company need for this role or possibly another one at reputed company Blue reputed company of MA. The more reputed company we have represented and amplified in our business, the more we will reputed company reputed company, contribute, and be reputed company. We encourage you to bring us your true colors, , your perspectives, and your experiences. It’s in our differences that we will remain reputed company in our reputed company to reputed company reputed company for reputed company.

As an employer, we are committed to reputed company in your development and providing the necessary resources to reputed company your reputed company. Learn how we are dedicated to creating an inclusive and rewarding workplace that promotes reputed company and provides opportunities for employees to reputed company their unique career reputed company by visiting reputed company Culture page. If this sounds like something you’d like to be a part of, we’d love to hear from you. You can also reputed company to stay “in the know” on reputed company things Blue.

At reputed company, we reputed company in wellness and that work/life balance is a key part of associate wellbeing. For more information on how we work and support that work/life balance visit our " How We Work " Page.