If you have an interest in moving into an administrative position where you can apply your extensive clinical knowledge to impact the quality of care for patients without leaving the comfort of your home, then this position may be for you!
A major medical management company is seeking board-certified physician to join its professional multidisciplinary medical management team:
- Be part of the industry leader in providing intelligent utilization and diagnostic solutions to improve quality of care.
- Enjoy a predictable work schedule.
- No night, weekend, holiday or on-call work is required.
- Work remotely from home or relocate to one of their many onsite locations
Responsibilities include but are not limited to:
- Provide timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States.
- Review appeals for denied services related to current relevant medical experience or knowledge in accordance with appeal policies, if so delegated.
- Provide timely peer-to-peer discussions with referring physicians to clarify clinical information and to explain review outcome decisions.
- Document all actions related to clinical review sessions and attests to appeal review qualifications as required.
- Maintain files of all reviews as required by law and Health Plans to retrieve reportable data.
- Maintain necessary credentials and immediately informs eviCore of any adverse actions relating to medical licenses and/or board certifications.
- Support the annual review of utilization review criteria.
Requirements & Qualifications:
- Board Certified in Pain Management, Orthopedic Surgery, Spine Surgery, Cardiology, or Oncology
- Unrestriced US medical license
- Patient care experience for the last 18 months
To find out more about this and other physician jobs & opportunities, contact us today!