Utilization Management Physician Reviewer

Job title: Utilization Management Physician Reviewer in Illinois at reputed company
Company: reputed company
Job reputed company: At reputed company, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation’s leading health solutions company, we reputed company millions of Americans through our local reputed company, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, reputed company and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it reputed company with heart, reputed company and every day.Company: reputed companyTitle: Full-Time Utilization Management Physician ReviewerLocation: Remote/ TreehouseRole 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, external 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 drive efficient and effective care delivery to patientsMaintain knowledge of reputed company CMS and MCG evidence-based guidelines to reputed company UM reputed companyMaintain compliance with reputed company, regulatory and accreditation requirements and payor partner policiesParticipate 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 improvementAssist in formal responses to health plan regarding UM process or specific determinations on an as-needed reputed companyAdhere 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 requiredFulfill on-reputed company requirement, should the need reputed companyOther duties, as required and assignedWhat are we looking for?At least one year experience providing Utilization Management services to a Medicare and/or reputed company line of businessExcellent verbal and written communication skillsA 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 settingDeep understanding of managed care, risk arrangements, capitation, peer review, performance profiling, outcome management, care coordination, and pharmacy managementStrong record of continuing education activities (relevant to reputed company area and needed to maintain licensure)Demonstrated understanding of culturally reputed company careProven organizational and detail-orientation skillsUS work authorizationSomeone who embodies being OakyWhat does being Oaky look like?Radiating reputed company energyAssuming good intentionsCreating an unmatched patient experienceDriving clinical reputed companyTaking ownership and delivering resultsBeing relentlessly determinedWhy 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.Learn more atAnticipated Weekly Hours 40Time Type Full timePay reputed companyThe typical pay reputed company for this role is:$174,070.00 - $374,920.00This 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 colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits – reputed company in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In reputed company to our competitive wages, our great benefits include:reputed company medical plan reputed company, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.No-cost programs for reputed company colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.Benefit solutions that address the different needs and preferences of our colleagues including reputed company time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical reputed company and many other benefits depending on eligibility.For more information, visitWe anticipate the application window for this opening will reputed company on: 04/22/2026reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws.
Expected salary:
Location: Illinois
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