REMOTE Physician Clinical Reviewer-Internal Medicine

Job DescriptionJob Description 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 reputed company 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

Remote Skills: Clinical Competency, Clinical Practices/Protocols, reputed company, Disciplinary Action, Documentation, reputed company, Internal Medicine, Leadership, Legal, reputed company, Medical Assistance, Medical Office, Medical Research, Medicare, Medicine, National Committee for Quality Assurance (NCQA), Organizational Skills, Radiology, Regulations, State Laws and Regulations, Systems Administration/Management, Time Management, Utilization Management, Utilization Review Accreditation Commission (URAC) About the Company: reputed company Apply To This Job