Physician Peer Reviewer for Utilization & Policy

61000 SelectHealth Inc; Murray (UT); On-site; USD 125,000 - 230,000; Full time

Benefits offered by this job

Generous benefits package

Job summary

Select Health, a community health plan, seeks a physician leader to provide peer review and clinical direction across utilization management, case management and policy development. You will collaborate with interdisciplinary teams to implement programs for the Office of the Medical Director and maintain high member satisfaction.

Responsibilities include reviewing coverage determinations, developing UM criteria, delivering clinical education, and supporting quality improvement while ensuring

Qualifications

• MD or DO required and board-certified in specialty
• Current MD/DO licensure in Utah, Idaho, Nevada or Colorado
• Five years of clinical practice experience and strong communication skills

Responsibilities

• Perform physician peer review and clinical direction for utilization management, case management, and appeals
• Develop and review utilization management screening criteria and policies
• Provide clinical education to UM/CM and HCS staff
• Review preauthorization requests and document decisions in care management system
• Represent Select Health on committees as assigned by Medical Director
• Identify opportunities to improve health service delivery and reduce costs without compromising quality

Skills

Leadership

Communication

Problem Solving

Taking Initiative

Analytical Thinking

Accountability

Collaboration

Professional Etiquette

Results-Oriented

Metrics

Education

MD/DO with Board Certification

Job description

Select Health, a community health plan, seeks a physician leader to provide peer review and clinical direction across utilization management, case management and policy development. You will collaborate with interdisciplinary teams to implement programs for the Office of the Medical Director and maintain high member satisfaction.

Responsibilities include reviewing coverage determinations, developing UM criteria, delivering clinical education, and supporting quality improvement while ensuring