Location: Springfield, IL
Our client is currently seeking a Physician Reviewer
Responsible for ensuring the company meets their product standards and commitments to customers and for ensuring physician utilization of company protocols, guidelines and policies/procedures. Primary duties may include, but are not limited to:
Maintains the quality and timeliness of peer clinical and/or appeal case review decision making across all product lines, consults with team members to ensure consistency, and superior customer service, improves service to clients and unit productivity through continuous enhancement of whole team clinical knowledge and enhanced understanding of company systems, products, programs, procedures and customers. Interprets existing policies and develops new policies based on changes in the healthcare or medical arena and supports the Medical Management staff ensuring timely and consistent responses to members and providers. Identifies and develops opportunities for innovation to increase effectiveness and quality. Serves as a resource and consultant to other areas of the company, may be required to represent the company to external entities and/or serve on external committees, conduct peer to peer clinical reviews with attending physicians or other ordering providers to discuss review determinations and provides guidance for clinical operational aspects of the program. Requires
M.D. or D.O.; Board certification approved by the American Board of Medical Specialties required, Must possess an active unrestricted medical license to practice medicine or a health profession. Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US, and 5 years clinical experience ; or any combination of education and experience, which would provide an equivalent background.Manager Notes:
Previous utilization management experience as a physician reviewer
o Current unrestricted medical license(s) as a Doctor of Medicine or Doctor of Osteopathic Medicine.
o Board Certified in Internal Medicine or an Internal Medicine Subspecialty, Pediatrics, Family Medicine or Physical Medicine and Rehabilitation
o Strong oral communication and interpersonal skills.
o Computer literacy with the ability to learn new applications.
o Ability to multi-task.
o Ability to work both independently and in a team environment.Schedule:
Location: Remote anywhere
Hours: Prefer 12-5PM Pacific time Wed, Thurs, Fri (but would also accept 10AM-5PM Thurs and 8:30-5pm Fri Pacific Time)
Noted hours are ideal - can be flexible for strong candidates but must discuss first.
Send qualified interested CV's to Dave Friedman
at Dfriedman@judge.com. Contact:
This job and many more are available through The Judge Group. Find us on the web at www.judge.com