Licensed Physician Reviewer- Pulmonology - 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 for each market, participating in health plan and local calls, and attending 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 Pulmonology preferred
• 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

Skills

• Knowledge of healthcare regulations and policies
• Ability to manage time effectively and prioritize tasks
• 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. Join our team and make a difference in people's lives every day.

For current employees interested in applying to our internal career site, please click HERE. For contingent workers interested in applying, please see the job aid HERE.