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An established industry player is seeking a dedicated medical professional to provide expert reviews and engage in meaningful discussions with referring physicians. This role is crucial in evaluating the medical necessity of services and ensuring compliance with appeal policies. The ideal candidate will possess a strong background in Oncology, with a commitment to maintaining high standards of patient care. Join a supportive organization that values collaborative culture and offers flexible scheduling, generous PTO, and opportunities for professional growth. If you are passionate about making a positive impact in healthcare while advancing your career, this is the perfect opportunity for you.
Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States.
Reviews appeals for denied services related to current relevant medical experience or knowledge in accordance with appeal policies, if so delegated.
Provides timely peer-to-peer discussions with referring physicians to clarify clinical information and to explain review outcome decisions.
Maintains necessary credentials and immediately informs eviCore of any adverse actions relating to medical licenses and/or board certifications.
Participates in strategic planning for and evaluation of the Care Management.
The successful candidate will be an M.D. or D.O. with a current, active, U.S. state medical license and board certified in Oncology, recognized by the American Board of Medical Specialties (ABMS), with recent practice experience in direct patient care (within the past 18 months).
Must have a minimum of 5 years clinical experience, beyond residency/fellowship.
Knowledge of applicable state and federal laws, URAC and NCQA standards a plus, and familiarity with automated processes and computer applications and systems is required.
Full and part time opportunities available. This is a salaried position with benefits.
Supportive organization with collaborative culture
eviCore healthcare is committed to making a positive impact on healthcare, and also making a positive impact on our employees. eviCore offers a variety of perks and benefits including, but not limited to:
eviCore is committed to hiring and retaining a diverse workforce. We are an Equal Opportunity Employer, making decisions without regard to race, color, religion, sex, national origin, age, veteran status, disability, or any other protected class. Applicants must be able to pass a drug test and background investigation.