Clinical Peer Reviewer - Utilization & Compliance

Healthfirst; Connecticut; On-site; USD 122,907 - 188,020; Full time

Benefits offered by this job

Medical, dental and vision coverage

Life insurance

401k contributions

Job summary

Healthfirst is seeking a Medical Peer Reviewer in Connecticut to join the CMO Administration team. This vital role involves consulting on medical necessity and ensuring adherence to regulations while reviewing authorization requests and claims.

The ideal candidate will be a licensed physician with board certification, ensuring compliance and productivity standards. Full-time positions require weekend coverage, and Healthfirst offers a competitive salary range of $122,907 - $188,020, depending on experience.

Qualifications

• Licensed medical professional with a focus on utilization management.
• Experience in clinical practice and compliance with regulations.

Responsibilities

• Assess and review authorization requests and claims.
• Collaborate with various departments on case management.
• Complete mandatory training and comply with policies.

Skills

Time management

Critical thinking

Communication

Problem-solving

Education

Licensed M.D. or D.O. or D.M.D. or D.D.S.

Board Certified in a specialty

Job description

Healthfirst is seeking a Medical Peer Reviewer in Connecticut to join the CMO Administration team. This vital role involves consulting on medical necessity and ensuring adherence to regulations while reviewing authorization requests and claims.

The ideal candidate will be a licensed physician with board certification, ensuring compliance and productivity standards. Full-time positions require weekend coverage, and Healthfirst offers a competitive salary range of $122,907 - $188,020, depending on experience.