Licensed Physician Reviewer - Urologist , PRN (remote)

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. The position will also participate in Process and Quality improvement in our developing area of Delegated Utilization Management.

Responsibilities

• 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
• Advises other physician reviewers
• Participates in Process and Quality improvement in our developing area of Delegated Utilization Management
• Provides Delegated UM by covering the specified territories as assigned

Requirements

• Graduate from accredited Medical School with a valid, unrestricted license
• Completion of Internal Medicine or Family Practice residency
• Board Certification in residency area - Urology
• 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 Utilization Management processes
• Ability to manage multiple tasks and meet deadlines
• Experience with healthcare regulatory requirements

Benefits

We offer a competitive salary range of $204,761 - $292,515, final compensation will depend 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
• Health and wellness programs
• Professional development opportunities
• Employee assistance program

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 please see job aid HERE to apply.