Clinical Peer Reviewer - Utilization & Compliance

Healthfirst; Town of Florida (NY); On-site; USD 122,907 - 188,020; Full time

Benefits offered by this job

Medical, dental and vision coverage

401k contributions

Incentive and recognition programs

Job summary

Healthfirst is seeking a Medical Peer Reviewer in the Town of Florida, NY, to consult on medical necessity within utilization management. This vital role involves reviewing authorization requests and ensuring compliance with Healthfirst's regulations.

The ideal candidate holds a valid medical license (M.D. or equivalent) and has expertise in utilization management. This position offers a salary range of $122,907 - $188,020 based on experience, as well as comprehensive benefits including health coverage, life insurance, and retirement contributions.

Qualifications

• Licensed M.D. or equivalent, Board Certified in a recognized specialty.
• Previous experience in utilization management is preferred.
• Knowledge of Medicare, Medicaid, and MLTC plans.

Responsibilities

• Assess and review requests for authorization and claims payment.
• Render determinations based on medical records.
• Collaborate with internal departments as needed.

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 recognized by the American Board of Medical Specialties

Job description

Healthfirst is seeking a Medical Peer Reviewer in the Town of Florida, NY, to consult on medical necessity within utilization management. This vital role involves reviewing authorization requests and ensuring compliance with Healthfirst's regulations.

The ideal candidate holds a valid medical license (M.D. or equivalent) and has expertise in utilization management. This position offers a salary range of $122,907 - $188,020 based on experience, as well as comprehensive benefits including health coverage, life insurance, and retirement contributions.