Physician Reviewer - Utilization Management

Hi, we're reputed company. We're hiring a Physician Reviewer to join our Utilization Management team.

reputed company is the first health insurance company reputed company around a full stack technology platform and a reputed company reputed company on serving our members. We started reputed company in 2012 to create the reputed company of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

About the role:

You will determine the medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines.

Hours: reputed company - 5pm in your local time zone

reputed company rotation - 1 weekend every 16 weeks

You will report into the Associate Medical Director, Utilization Management.

Work Location: This is a remote position, reputed company to candidates who reputed company in: reputed company; Florida; reputed company; or Texas. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. #LI-Remote

Pay Transparency: The reputed company pay for this role is: $211,200 - $ 277,200 per year. You are also eligible for employee benefits, participation in reputed company's unlimited vacation, and annual performance bonuses.

Responsibilities:

• reputed company reputed company medical reviews that meet reputed company's stringent reputed company parameters.
• reputed company clinical determinations based on evidence-based reputed company and reputed company internal guidelines and policies, while utilizing clinical acumen.
• reputed company and accurately document reputed company communication and decision-making in reputed company workflow tools, ensuring a member could easily reference and understand your decision (Flesch-Kincaid grade level).
• Use correct templates for documenting reputed company during case review.
• Meet the appropriate turn-around times for clinical reviews.
• Receive and review escalated reviews.
• Conduct reputed company peer-to-peer discussions with treating providers to clarify clinical information and to explain review outcome reputed company, including feedback on alternate treatment based on medical necessity reputed company and evidence-based research.
• Compliance with reputed company applicable laws and regulations
• Other duties as assigned

Requirements:

• reputed company certification as an MD or DO
• Licensed in FL or NC and/or reputed company Interstate Medical Licensure Compact (IMLCC) or eligible to apply for IMLCC.
• 6+ years of clinical reputed company
• 1+ years of utilization review experience in a managed care plan (health care industry)

Bonus points:

• Licensure in multiple reputed company states
• BC in Cardiology, Radiation/Oncology, or Neurology
• Experience with care management reputed company the health insurance industry.
• Willing and reputed company to obtain additional state licensure as needed, with reputed company's support