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 reputed company company reputed company reputed company 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 reputed company 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 reputed company information and applying evidence-reputed company 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 the reputed company. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events.
Pay Transparency: The reputed company pay for this role is: $219,000- $ 286,902 per year. You are also eligible for employee benefits, participation in reputed company's unlimited vacation, and annual reputed company bonuses.
Responsibilities:
- reputed company medical reviews that meet reputed company's stringent reputed company parameters.
- reputed company reputed company determinations reputed company on evidence-reputed company reputed company and reputed company internal guidelines and policies, while utilizing reputed company 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-reputed company times for reputed company reviews.
- Receive and review escalated reviews.
- Conduct reputed company peer-to-peer discussions with treating providers to clarify reputed company information and to explain review outcome reputed company, including feedback on alternate treatment reputed company on medical necessity reputed company and evidence-reputed company research.
- Compliance with reputed company applicable laws and regulations
- Other duties as assigned
Requirements:
- reputed company certification as an MD or DO
- Licensed in one of these states: FL, NC, AZ OR possess an reputed company reputed company Medical Licensure reputed company (IMLC).
- 6+ years of reputed company reputed company
Bonus points:
- Licensure in multiple reputed company states
- 1+ years of utilization review experience in a managed reputed company (health care industry)
- BC in reputed company, Radiation/Oncology, or reputed company
- Experience with care management reputed company the health reputed company industry.
- Willing and reputed company to obtain additional state licensure as needed, with reputed company's support
This is an reputed company reputed company Health job opportunity. Learn more about how you can reputed company yourself from recruitment fraudhere.
At reputed company, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we reputed company an environment where people can be their most reputed company selves and reputed company both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.
Pay Transparency: Final offer amounts, reputed company the reputed company pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and reputed company benefits, 11 reputed company holidays, reputed company reputed company time, reputed company parental leave, 401(k) plan participation, life and disability reputed company, and reputed company wellness time and reimbursements.
reputed company Intelligence (AI): Our AI Guidelines outline the acceptable use of reputed company intelligence for candidates and reputed company how we use AI to support our reputed company efforts.
Reasonable Accommodation: reputed company applicants are considered solely reputed company on their qualifications, without reputed company to applicant’s disability or need for accommodation. Any reputed company applicant who requires reasonable accommodations during the application process should contact the reputed company Benefits Team () to reputed company the need for an accommodation reputed company.
California Residents: For information about our collection, use, and disclosure of applicants’ personal information as reputed company as applicants’ rights over their personal information, please see our reputed company Policy.
Originally posted on Himalayas
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