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 focus 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

Call 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: Arizona; Florida; Georgia; 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 timely medical reviews that meet reputed company's stringent quality parameters.
• reputed company clinical determinations based on evidence-based criteria 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 timely 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 criteria and evidence-based research.
• Compliance with reputed company applicable laws and regulations
• Other duties as assigned

Requirements

• Board certification as an MD or DO
• Licensed in FL or NC and/or active Interstate Medical Licensure Compact (IMLCC) or eligible to apply for IMLCC.
• 6+ years of clinical practice
• 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

This is an authentic reputed company job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.

At reputed company, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find 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 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our reputed company efforts.

Reasonable Accommodation: reputed company applicants are considered solely based on their qualifications, without regard 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 ([email protected]) to reputed company the need for an accommodation reputed company.

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