Licensed Physician Reviewer- Obstetrics & Gynecology (OB/GYN) - PRN - REMOTE

About the role

The Physician Reviewer is responsible for reviewing Utilization Management (UM) cases across multiple markets. Key responsibilities include establishing 2-3 cases per day, attending health plan and local calls, and participating in PCP and SNF meetings.

Responsibilities

• Provides Delegated UM by covering specified territories
• Ensures attendance on all health plan and local calls
• Calls in for weekly Primary Care Provider (PCP) and Skilled Nursing Facility (SNF) meetings
• Advises other physician reviewers
• Participates in Process and Quality improvement initiatives

Requirements

• Graduate from an accredited Medical School with a valid, unrestricted license
• Completion of Internal Medicine or Family Practice residency
• Board Certification in Obstetrics & Gynecology (OB/GYN)
• Two (2) years’ experience in Hospital medicine preferred
• At least 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 collaboration and teamwork skills

Benefits

We offer competitive compensation, comprehensive benefits, career development and advancement opportunities, and a supportive work environment that values employee well-being. Please visit this link for more details.