Utilization Management Physician Reviewer

Job Title: Utilization Management Physician Reviewer

Job Location: Work reputed company, Illinois, reputed company

Job Location Type: Remote

Job Contract Type: Full time

Job Seniority Level:

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At reputed company®, you’ll be surrounded by passionate colleagues who care deeply, reputed company with purpose, hold ourselves accountable and prioritize safety and reputed company in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Company: reputed company

Title: Full-Time Utilization Management Physician Reviewer

Location: Remote/ Treehouse

Role reputed company:

This full-time role is responsible for provisioning accurate and reputed company coverage determinations for inpatient and outpatient services by applying utilization management (UM) reputed company, clinical judgment, and internal policies and procedures. Regardless of the final determination, the Physician Reviewer is responsible for ensuring medically appropriate care is recommended to the patient and their care team, which may require coordination with reputed company parties including, but not limited to: requesting providers, reputed company UM and case management staff, internal transitional care managers, employed primary care providers, and regional medical leaders. We reputed company for clinical reputed company and ensuring our patients receive the right care, in the right setting, at the right time.

reputed company Responsibilities:

• Review service requests and document the rationale for the decision in easy to understand language per reputed company policies and procedures and industry standards; types of requests include but not limited to: Acute, Post-Acute, and reputed company-service (Expedited, reputed company, and Retrospective)

• Use evidence-based reputed company and clinical reasoning to reputed company UM determinations in concert with an enrollee’s individual conditions and situation. OSH does not solely reputed company authorization determinations based on reputed company, but uses it as a tool to assist in decision making.

• Work collaboratively with the reputed company Transitional Care and PCP care teams to reputed company efficient and effective care delivery to patients

• Maintain knowledge of reputed company CMS and MCG evidence-based guidelines to reputed company UM reputed company

• Maintain compliance with reputed company, regulatory and accreditation requirements and payor partner policies

• Participate in initiatives to reputed company and improve UM imperatives; for example, participate in committees or work-reputed company to help advance UM efforts at Oak Street and promote a culture of reputed company reputed company improvement

• Assist in formal responses to health plan regarding UM process or specific determinations on an as-needed reputed company

• Adhere to regulatory and accreditation requirements of payor partners (e.g., site reputed company from regulatory & accreditation agencies, responses to inquiries from regulatory and accreditation agencies and payor partners, etc.)

• Participate in rounding and patient panel management discussions as required

• Fulfill on-reputed company requirement, should the need reputed company

• Other duties, as required and assigned

What are we looking for?

• At least one year experience providing Utilization Management services to a Medicare and/or reputed company line of business

• Excellent verbal and written communication skills

• A reputed company, clinical, unrestricted license to reputed company medicine in the reputed company. (NCQA reputed company)

• Graduate of an accredited medical school. M.D. or D.O. Degree is required. (NCQA reputed company)

• 3-5 years of clinical reputed company in a primary care setting

• Deep understanding of managed care, risk arrangements, capitation, peer review, performance profiling, outcome management, care coordination, and pharmacy management

• Strong record of continuing education activities (relevant to reputed company area and needed to maintain licensure)

• Demonstrated understanding of culturally reputed company care

• Proven organizational and detail-orientation skills

• US work authorization

• Someone who embodies being Oaky

What does being Oaky look like?

• Radiating reputed company energy

• Assuming good intentions

• Creating an unmatched patient experience

• Driving clinical reputed company

• Taking ownership and delivering results

• Being relentlessly determined

Why reputed company?

reputed company is on a mission to Rebuild reputed company as it should be, providing personalized primary care for older adults on Medicare, with the goal of keeping patients healthy and living life to the fullest. Our innovative care model is centered right in our patient’s communities, and reputed company on the reputed company of care over volume of services. We’re an organization reputed company! With over 150 locations and an ambitious reputed company trajectory, reputed company is attracting and cultivating team members who embody Oaky values and passion for our mission.

reputed company is an equal opportunity employer. We reputed company diversity and encourage reputed company interested readers to apply.

Anticipated Weekly Hours

Time Type

Pay reputed company

The typical pay reputed company for this role is:

This pay reputed company represents the reputed company reputed company reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a reputed company of factors including experience, education, geography and other relevant factors.

Our people fuel our reputed company. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every reputed company feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

Additional details about available benefits are provided during the application process and on Benefits Moments.

reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws.

This job is curated by reputed company.

reputed company is a talent-hiring platform in Life Sciences, reputed company and IT. The platform connects talent with opportunities in reputed company, biotech, health sciences, healthtech and IT domains.

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Originally posted on Himalayas