Clinical Policy & Benefits Physician Advisor

UMass Med School; Westborough (MA); On-site; USD 185,000 - 250,000; Full time

Job summary

UMass Medical School in Westborough, MA seeks a Physician Advisor to review applicant medical records and render clinical determinations for benefits and long-term care.

Under the direction of the Medical Director, you will guide reviewers, participate in quality improvement, and train new Physician Advisors while ensuring compliance with federal and state regulations. This is a full-time exempt role based in Westborough.

Qualifications

• Board eligible or certified in area of specialty.
• Minimum of 5 years of experience in direct patient care.
• Ability to plan and prioritize work to meet position objectives.
• Excellent problem solving and decision making capabilities.

Responsibilities

• Determin evidence-based clinical criteria for benefits and long-term care eligibility.
• Review medical records; approve or deny RN reviewer recommendations.
• Assess functional capability from comprehensive records.

Skills

Board eligibility/certification

Direct patient care

Prioritization

Problem solving

Job description

UMass Medical School in Westborough, MA seeks a Physician Advisor to review applicant medical records and render clinical determinations for benefits and long-term care.

Under the direction of the Medical Director, you will guide reviewers, participate in quality improvement, and train new Physician Advisors while ensuring compliance with federal and state regulations. This is a full-time exempt role based in Westborough.