Physician Clinical Reviewer – Endocrinology
Job Description:
• Reviews cases in which clinical determinations cannot be made by the Initial Clinical Reviewer.
• Discusses determinations with requesting physicians or ordering providers, when available, within the regulatory time frame of the request by phone or fax.
• Provides clinical rationale for standard and expedited appeals.
• Provides assistance and acts as a resource to Initial Clinical Reviewers as needed to discuss cases and problems.
• Ensures documentation of all communications with medical office staff and/or physician/provider is recorded in a timely and accurate manner.
• Participates in on-going inter-rater reliability training and testing
• Assists the Medical Director and/or VP, Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines, and/or system support.
Requirements:
• Doctor of Medicine (MD), Doctor of Osteopathic Medicine (DO) or international degree with successful completion of United States based internship and residency
• Current, unrestricted license to practice medicine in one or more states of the United States
• Board Certified by American Board of Medical Specialties (ABMS), American Board of Osteopathic Specialties (ABOS), American Board of Internal Medicine or American Board of Osteopathic Internal Medicine (ABIM/ABOIM)
• 1 year of work experience in clinical review
• Must be eligible to work in the United States without the need for work visa or residency sponsorship.
Benefits:
• Health insurance
• Health and wellness programs
• Paid time off
• Professional development opportunities
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• Reviews cases in which clinical determinations cannot be made by the Initial Clinical Reviewer.
• Discusses determinations with requesting physicians or ordering providers, when available, within the regulatory time frame of the request by phone or fax.
• Provides clinical rationale for standard and expedited appeals.
• Provides assistance and acts as a resource to Initial Clinical Reviewers as needed to discuss cases and problems.
• Ensures documentation of all communications with medical office staff and/or physician/provider is recorded in a timely and accurate manner.
• Participates in on-going inter-rater reliability training and testing
• Assists the Medical Director and/or VP, Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines, and/or system support.
Requirements:
• Doctor of Medicine (MD), Doctor of Osteopathic Medicine (DO) or international degree with successful completion of United States based internship and residency
• Current, unrestricted license to practice medicine in one or more states of the United States
• Board Certified by American Board of Medical Specialties (ABMS), American Board of Osteopathic Specialties (ABOS), American Board of Internal Medicine or American Board of Osteopathic Internal Medicine (ABIM/ABOIM)
• 1 year of work experience in clinical review
• Must be eligible to work in the United States without the need for work visa or residency sponsorship.
Benefits:
• Health insurance
• Health and wellness programs
• Paid time off
• Professional development opportunities
Apply tot his job
Apply To this Job