Physician Reviewer

EPITEC; Tennessee; On-site; USD 150,000 - 230,000; Full time

Benefits offered by this job

Opportunity to make a meaningful impact

Collaborative work environment

Professional development opportunities

Job summary

A healthcare organization in Tennessee is seeking a Physician Reviewer to ensure high-quality, cost-effective care for members. This role involves reviewing clinical service requests, providing expert opinions, and developing policies to enhance health outcomes. Ideal candidates should possess a Board Certified M.D. or D.O., have at least 5 years of clinical experience, and demonstrate strong analytical and communication skills. The position offers opportunities for professional growth and a collaborative work environment.

Qualifications

• Board Certified (ABMS) M.D. or D.O., with an active license.
• 5 years clinical experience, including inpatient experience.
• Understanding of managed care and proficiency in electronic medical records.

Responsibilities

• Review clinical service requests and provide expert opinions.
• Contribute to the development of policies and procedures.
• Work closely with the team to drive better health outcomes.

Skills

Board Certified (ABMS) M.D. or D.O., unrestricted and active license to practice medicine

5 years clinical experience

Understanding of managed care

Strong clinical judgment and analytical skills

Excellent communication and interpersonal skills

Education

Master's degree in Healthcare Administration or related field

Job description

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Hours: Mon-Fri Core business hours 40hr/week

Overview

As a Physician Reviewer, you'll play a critical role in ensuring that our members receive high-quality, cost-effective care. You'll work closely with our team to review clinical service requests, provide expert opinions, and develop policies and procedures that align with our organization's criteria. Your expertise will help us identify opportunities for creative problem-solving and anticipation of future clinical problems, ultimately driving better health outcomes for our members.

Responsibilities

Responsibilities include reviewing clinical service requests, providing expert opinions, and contributing to the development of policies and procedures that align with organizational criteria to improve health outcomes for members.

Required Skills

• Board Certified (ABMS) M.D. or D.O., unrestricted and active license to practice medicine
• 5 years clinical experience, including inpatient experience, or equivalent education and experience
• Understanding of managed care and proficiency in PC (electronic medical records)
• Strong clinical judgment and analytical skills
• Excellent communication and interpersonal skills

Nice to Have Skills

• 10 years clinical experience
• Experience with managed care and utilization management
• Strong leadership and management skills

Preferred Education and Experience

• Master's degree in Healthcare Administration, Public Health, or related field (optional)

Other Requirements

• Ability to work independently and as part of a team
• Strong organizational and time management skills
• Ability to maintain confidentiality and handle sensitive information
• Willingness to participate in continuous quality improvement activities

What We Offer

• Opportunity to make a meaningful impact in the lives of our members
• Collaborative and dynamic work environment
• Professional development and growth opportunities