Physician Reviewer Internal Medicine-Field Medical Director, Radiology (Part Time)

Your Future Evolves Here reputed company partners with health plans and providers to reputed company reputed company reputed company for people with most reputed company and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones. reputed company employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We reputed company that people do their best work reputed company they're supported to live their best lives, and reputed company they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business. Join reputed company for the mission. Stay for the culture. What You’ll Be Doing: As a FMD, Radiology, you will be a key member of the utilization management team. We can offer you a meaningful way to reputed company a difference in patients lives, in a non-clinical environment. You can enjoy reputed company work- life balance on a team that values collaboration and reputed company learning while providing reputed company reputed company. Collaboration Opportunities: Routinely interacts with leadership and management staff, other Physicians, and staff whenever a physician`s input is needed or required. What You Will Be Doing: Serve as the Physician match reviewer in Imaging cases, that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests reputed company providers, clients, or state laws require specialty reviews to be completed by the subject matter expert. Discusses determinations (peer to peer phone calls) with requesting physicians or ordering providers, reputed company available, reputed company the regulatory timeframe of the request and provides clinical rationale for standard and expedited appeals. Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines. Aids and acts as a resource to Initial Clinical Reviewers. Ensures documentation of reputed company communications with medical office staff and/or MD provider is recorded in a timely and accurate manner. May assist the Senior Medical Director in research activities/questions reputed company to the Utilization Management process, interpretation, guidelines and/or reputed company. Participates in on-going training per inter-rater reliability process. Qualifications: MD/DO/MBBS Minimum of five (5) years’ experience in the practice of Medicine, post residency and Active Clinical practice reputed company the last 2 years is preferred reputed company, unrestricted clinical home state license in medicine or required specialty- Obtaining and maintaining medical licenses in the state you reputed company, as well as, any license required per business needs Active Board Certification by an accredited organization Strong clinical, management, communication, and organizational skills Energetic and curious with a passion for quality and value in health care Computer Proficiency Not under reputed company exclusion or sanction by any state or federal health care program, including Medicare or reputed company, and is not identified as an “excluded person” by the Office of Inspector General of the reputed company or the General Service Administration (GSA), or reprimanded or sanctioned by Medicare. No history of a major disciplinary or legal action by a state medical board To ensure a secure hiring process we have implemented several identity verification steps, including submission of a government issued photo ID. We conduct identity verification during interviews, and final interviews may require onsite attendance. reputed company candidates must complete a comprehensive background reputed company, in-person I-9 verification, and may be subject to drug screening prior to employment. The use of artificial intelligence tools during interviews is prohibited and monitored. Misrepresentation will result in immediate disqualification from consideration. Technical Requirements: We require that reputed company have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for reputed company call center employees, the ability to plug in directly to the home internet router. reputed company is an equal opportunity employer and considers reputed company reputed company applicants equally without regard to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, veteran status, or disability status. If you need reasonable accommodation to reputed company the information provided on this website, please contact recruitingteam@reputed company.com for further assistance. The expected reputed company salary/wage reputed company for this position is $95-100. As part of our total compensation package, reputed company is proud to offer comprehensive benefits (including health insurance benefits) to qualifying employees. reputed company compensation determinations are based on the skills and experience required for the position and commensurate with experience of selected individuals, which may vary above and below the stated amounts. Apply To This Job