Physician Reviewer – Utilization Management & Quality Improvement

ChenMed LLC; United States; On-site; USD 205,000 - 293,000; Full time

Job summary

ChenMed is seeking a Physician Reviewer to lead Utilization Management reviews across assigned markets. The role involves advising other reviewers, attending daily health plan calls, and coordinating care for our patients.

Candidates with Internal Medicine or Family Practice training, board certification in Infectious Disease, and hospital medicine/ utilization review experience are preferred. ChenMed offers a physician-led, growth-focused environment committed to improving care for seniors.

Qualifications

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

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.

Skills

Analytical reasoning

Problem solving

Communication skills

Organizational skills

English fluency

MS Office

Education

MD or DO with valid license

Internal Medicine or Family Practice residency

Board Certification in Infectious Disease

Hospital medicine experience

Utilization review experience

Job description

ChenMed is seeking a Physician Reviewer to lead Utilization Management reviews across assigned markets. The role involves advising other reviewers, attending daily health plan calls, and coordinating care for our patients.

Candidates with Internal Medicine or Family Practice training, board certification in Infectious Disease, and hospital medicine/ utilization review experience are preferred. ChenMed offers a physician-led, growth-focused environment committed to improving care for seniors.