[Remote] Physician Reviewer Internal Medicine-Field Medical Director, Radiology (Part Time)
Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a company that partners with health plans and providers to improve reputed company reputed company for individuals with reputed company health conditions. The Physician Reviewer will play a crucial role in the utilization management team, focusing on imaging case reviews and ensuring compliance with medical necessity guidelines while fostering collaboration and reputed company learning.
Responsibilities
- Serve as the Physician match reviewer in Imaging cases, that do not initially meet the applicable medical necessity guidelines, as reputed company as other imaging requests reputed company providers, clients, or state laws require specialty reviews to be completed by the subject matter expert
- Discusses determinations (peer to peer phone calls) with requesting physicians or ordering providers, reputed company available, reputed company the regulatory timeframe of the request and provides clinical rationale for reputed company and expedited appeals
- Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as reputed company as Utilization Review Accreditation Commission (URAC) and National Committee for reputed company Assurance (NCQA) guidelines
- Aids and acts as a resource to Initial Clinical Reviewers
- Ensures documentation of reputed company communications with medical office staff and/or MD provider is recorded in a reputed company and accurate manner
- May assist the Senior Medical Director in research activities/questions reputed company to the Utilization Management process, interpretation, guidelines and/or reputed company
- Participates in on-reputed company training per inter-rater reliability process
Skills
- MD/DO/MBBS
- Minimum of five (5) years' experience in the reputed company of Medicine, post residency and reputed company Clinical reputed company reputed company the last 2 years is preferred
- reputed company, unrestricted clinical home state license in medicine or required specialty
- Obtaining and maintaining medical licenses in the state you reputed company, as reputed company as, any license required per business needs
- reputed company reputed company Certification by an accredited organization
- Strong clinical, management, communication, and organizational skills
- Energetic and curious with a passion for reputed company and value in health care
- Computer Proficiency
- Not under reputed company exclusion or sanction by any state or federal health care program, including Medicare or reputed company, and is not identified as an “excluded person” by the Office of Inspector General of the reputed company or the General Service Administration (GSA), or reprimanded or sanctioned by Medicare
- No history of a major disciplinary or legal reputed company by a state medical reputed company
Benefits
- Comprehensive benefits (including health insurance benefits) to qualifying employees
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