Licensed Physician Reviewer - Nephrologist

ChenMed; Miami (FL); On-site; USD 205,000 - 293,000; Full time

Benefits offered by this job

Employee benefits

Job summary

ChenMed in Miami, FL is seeking a Physician Reviewer to serve as the primary physician reviewer for Utilization Management (UM) cases, advising colleagues and coordinating care with health plan teams and local teams.

The role emphasizes process and quality improvement in Delegated UM and requires an MD with Internal Medicine or Family Practice residency, board certification, and two years of hospital medicine experience. Strong analytical and communication skills are essential.

Qualifications

• Graduate from an accredited medical school with a valid, unrestricted license.
• Completion of Internal Medicine or Family Practice residency.
• Board certification in the residency area.

Responsibilities

• Provide Delegated UM by covering designated territories and participating in meetings.
• Establish 2-3 UM cases per day per market and attend weekly health plan/local calls.
• Advise other physician reviewers and coordinate care with teams.
• Perform other duties as assigned and updated by management.

Skills

Analytical skills

Judgement

Communication skills

Organizational skills

English fluency

MS Office proficiency

Education

Medical Degree (MD)

Internal Medicine residency

Board certification

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?

We’re different than most primary care providers. We’re rapidly expanding and we need great people to join our team.

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.