Licensed Physician Reviewer, Ophthalmology - Remote PRN
About the role
The Physician Reviewer is the primary physician reviewer for Utilization Management (UM) cases in our organization. Other duties include advising other physician reviewers and attending daily calls with health plan teams and local teams assisting with this function and coordinating care for our patients.
Responsibilities
- Advise other physician reviewers.
- Participate in Process and Quality improvement in our developing area of Delegated Utilization Management.
- Provides Delegated UM by covering the specified territories as assigned:
- Establish 2-3 cases a day for each market covered (up to 6 markets).
- Ensures attendance on all health plan and local calls.
- Calls in for the weekly Primary Care Provider (PCP) and Skilled Nursing Facility (SNF) meetings covering the assigned territories.
Requirements
- Graduate from accredited Medical School with a valid, unrestricted license.
- Completion of Internal Medicine or Family Practice residency.
- Board Certification - Ophthalmology.
- 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 judgement and problem-solving skills.
- Professional and effective communication skills.
- Strong organizational skills.
- Written and verbal fluency in English.
- Proficient in the use of Microsoft Office products such as Outlook, Excel, Word and PowerPoint.
Skills
- Knowledge of healthcare regulations and policies.
- Ability to manage multiple tasks and prioritize effectively.
- Experience with healthcare software and systems.
Benefits
We offer a competitive salary range of $204,761 - $292,515, final compensation depending on a variety of factors including but not limited to experience, education, geographic location, and other relevant factors. This position may also be eligible for bonuses or commissions. Employee benefits include:
- Comprehensive medical, dental, and vision insurance.
- Paid time off and holidays.
- Flexible spending accounts for healthcare and dependent care expenses.
- Retirement savings plans with company matching.
- Employee assistance programs.
- Professional development opportunities.
- Work-life balance initiatives.
Join our team who make a difference in people’s lives every single day. Current employees, if you want to apply to our internal career site, please click HERE. Current contingent workers can apply via the job aid HERE.