Licensed Physician Reviewer- Infectious Disease - PRN - REMOTE

About the role

The Physician Reviewer is responsible for reviewing Utilization Management (UM) cases within the organization. Key responsibilities include providing delegated UM coverage, participating in health plan and local calls, and attending PCP and SNF meetings.

Responsibilities

• Provides Delegated UM by covering specified territories, establishing 2-3 cases per day for each market covered (up to 6 markets)
• Affirms attendance on all health plan and local calls
• Calls in for weekly Primary Care Provider (PCP) and Skilled Nursing Facility (SNF) meetings covering the assigned territories
• Advises other physician reviewers
• Participates in Process and Quality Improvement initiatives related to Delegated Utilization Management

Requirements

• Graduate from an accredited Medical School with a valid, unrestricted license
• Completion of Internal Medicine or Family Practice residency
• Board Certification in Infectious Disease preferred
• Two (2) years’ experience in Hospital medicine preferred
• One (1) year of utilization review experience preferred

Qualifications

• Excellent analytical and deductive reasoning skills
• Good judgment and problem-solving skills
• Professional and effective communication skills
• Strong organizational skills
• Written and verbal fluency in English
• Proficient in Microsoft Office products such as Outlook, Excel, Word, and PowerPoint

Skills

• Knowledge of healthcare regulations and policies
• Ability to manage multiple tasks simultaneously
• Strong interpersonal and collaboration skills

Benefits

We offer a competitive salary range of $204,761 - $292,515, with potential for bonuses or commissions. Our comprehensive benefits package includes:

• Health insurance
• Dental insurance
• Vision insurance
• Paid time off
• Flexible spending accounts
• Retirement plans
• Employee assistance programs
• Professional development opportunities
• Work-life balance initiatives

Join our team of dedicated professionals making a difference in people's lives every day.