Licensed Physician Reviewer-3

Physician Pivot; United States; On-site; USD 205,000 - 293,000; Full time

Job summary

ChenMed in the United States seeks a Physician Reviewer to lead Utilization Management (UM) case reviews across assigned markets and coordinate care with health plan teams and local staff.

You will support process and quality improvements, advise other reviewers, and ensure compliant UM activities. The role requires MD, residency in Internal Medicine or Family Practice, board certification, and strong analytical and communication skills. This is a full-time position with competitive pay.

Qualifications

• Graduate from accredited Medical School with a valid, unrestricted license.
• Completion of Internal Medicine or Family Practice residency.
• Board Certification in residency area.

Responsibilities

• Produces Delegated UM by covering the specified territories as assigned.
• Establishes 2–3 cases a day for each market covered (up to 6 markets); attends health plan and local calls.
• Advises other physician reviewers.
• Other duties as assigned and modified by manager.

Skills

Analytical skills

Deductive reasoning

Communication skills

Organizational skills

Written & verbal English

MS Office proficiency

Education

Medical Degree (MD/DO)

Internal Medicine or Family Practice residency

Board Certification

Tools

Microsoft Office Suite

Job description

We’re unique. You should be, too.

We’re changing lives every day. For both our patients and our team members. Are you innovative and entrepreneurial minded? Is your work ethic and ambition off the charts? Do you inspire others with your kindness and joy?

Responsibilities

The Physician Reviewer is the primary physician reviewer for Utilization Management (UM) cases in our organization. Other duties include advising other physician reviewers and attending daily calls with health plan teams and our local teams assisting with this function and coordinating care for our patients. The position will also participate in Process and Quality improvement in our developing area of Delegated Utilization Management.

ESSENTIAL JOB DUTIES/RESPONSIBILITIES:

• Provides Delegated UM by covering the specified territories as assigned:
• Establish 2-3 cases a day for each market covered (up to 6 markets); ensures attendance on all health plan and local calls; calls in for the weekly Primary Care Provider (PCP) and Skilled Nursing Facility (SNF) meetings covering the assigned territories.
• Advises other physician reviewers.
• Other duties as assigned and modified by manager.

Knowledge, Skills And Abilities

• Excellent analytical and deductive reasoning skills
• Good judgement and problem-solving skills
• Professional and effective communication skills
• Strong organizational skills
• Written and verbal fluency in English
• Proficient in the use of Microsoft Office products such as Outlook, Excel, Word and PowerPoint

Education And Experience Criteria

• Graduate from accredited Medical School with a valid, unrestricted license is required
• Completion of Internal Medicine or Family Practice residency
• Board Certification in residency area
• Two (2) years’ experience in Hospital medicine preferred
• At least one (1) year of utilization review experience preferred

Pay Range

$204,761 - $292,515 Salary The posted pay range represents the base hourly rate or base annual full-time salary for this position. Final compensation will depend on a variety of factors including but not limited to experience, education, geographic location, and other relevant factors. This position may also be eligible for a bonuses or commissions.

Employee Benefits

https://chenmed.makeityoursource.com/helpful-documents

We’re ChenMed and we’re transforming healthcare for seniors and changing America’s healthcare for the better. Family-owned and physician-led, our unique approach allows us to improve the health and well-being of the populations we serve. We’re growing rapidly as we seek to rescue more and more seniors from inadequate health care.

ChenMed is changing lives for the people we serve and the people we hire. With great compensation, comprehensive benefits, career development and advancement opportunities and so much more, our employees enjoy great work-life balance and opportunities to grow. Join our team who make a difference in people’s lives every single day.