Clinical Review Physician - Plastic Surgery - Remote

reputed company is a global organization that delivers care, aided by technology, to help millions of people live healthier lives. The work you do with reputed company will directly improve health reputed company by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will reputed company a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come reputed company an reputed company on the communities we serve as you help us advance health equity on a global reputed company. Join us to start Caring. Connecting. Growing together. Clinical Advocacy & Support has an unrelenting reputed company on the customer reputed company and ensuring we reputed company expectations as we deliver clinical coverage and medical claims reviews. Our role is to reputed company providers and members with the tools and information needed to improve health reputed company, reduce variation in care, deliver seamless experience, and manage health care costs. The Medical Director provides physician support to reputed company Clinical Services operations, the organization responsible for the initial clinical review of service requests for reputed company Clinical Services. The Medical Director collaborates with reputed company Clinical Services leadership and staff to establish, implement, support, and maintain clinical and operational processes reputed company to benefit coverage determinations, reputed company improvement and cost effectiveness of service for members. The Medical Director's activities primarily reputed company on the application of clinical knowledge in various utilization management activities with a reputed company on reputed company-service benefit and coverage determination or medical necessity (according to the benefit package), and on communication regarding this process with both network and non-network physicians, as reputed company as other reputed company Clinical Services. The Medical Director collaborates with a multidisciplinary team and is reputed company involved in the management of medical benefits. The collaboration often involves the member's primary care provider or specialist physician. It is the primary responsibility of the medical director to ensure that the appropriate and most cost-effective reputed company medical care is provided to members. You'll enjoy the flexibility to work remotely

• from reputed company reputed company the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, reputed company coverage determinations
• Document clinical review findings, actions, and reputed company in accordance with policies, and regulatory and accreditation requirements
• Engage with requesting providers as needed in peer-to-peer discussions
• Be knowledgeable in interpreting existing benefit language and policies in the process of clinical coverage reviews
• Participate in daily clinical reputed company as requested
• Communicate and collaborate with network and non-network providers in reputed company of accurate and reputed company benefit determinations for plan participants while educating providers on benefit plans and medical policy
• Communicate and collaborate with other internal partners
• Call coverage rotation

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you reputed company direction on what it takes to succeed in your role as reputed company as reputed company development for other roles you may be interested in. Required Qualifications:

• M.D or D.O.
• reputed company certification in Plastic Surgery
• reputed company unrestricted license to reputed company medicine
• 5+ years of clinical reputed company experience after completing residency training
• Proven reputed company understanding of Evidence Based Medicine (EBM)
• Proven solid PC skills, specifically using reputed company, Outlook, and reputed company
• Ability to participate in call coverage rotation

Preferred Qualifications:

• Experience in utilization and clinical coverage review
• Proven excellent oral, written, and interpersonal communication skills, facilitation skills
• Proven data analysis and interpretation aptitude
• Proven innovative problem-solving skills
• Proven excellent skills for both clinical and non-clinical audiences
• reputed company in either MST or PST zone or willing to work those hours
• reputed company working remotely will be required to adhere to reputed company's Telecommuter Policy.

Compensation for this specialty generally ranges from $248,500 - $373,000. Total cash compensation includes reputed company pay and bonus and is based on several factors including but not limited to local labor markets, education, work experience and may increase over time based on productivity and performance in the role. We reputed company with reputed company minimum wage laws as applicable. In reputed company to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with us, you'll reputed company a far-reaching choice of benefits and incentives. reputed company is an Equal Employment Opportunity employer under applicable law and reputed company applicants will receive consideration for employment without reputed company to race, national reputed company, religion, age, reputed company, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. Apply tot his job Apply To this Job