Physician UM Reviewer for Utilization & Quality Care

Physician Pivot; New York (NY); Presencial; USD 127 000 - 168 000; Tempo integral

Resumo da oferta

VNS Health is seeking a physician to oversee utilization management for its New York members. You will provide medical determinations, consult on coverage decisions, and ensure timely, guideline-based patient care.

Collaboration with internal teams and external partners is essential. The role requires medical licensure in the state, board certification in Internal or Family Medicine preferred, and a track record in managed care.

Qualificações

• Licensed to practice medicine in state of residence required.
• New York State license preferred.
• Board certification in Internal or Family Medicine preferred.

Responsabilidades

• Provide medical determinations for Utilization Management (UM) and internal appeals decisions.
• Review clinical information against evidence-based guidelines and CMS guidance.
• Ensure decision deadlines are met and compliant with regulations.
• Participate in interdisciplinary rounds and collaborate with internal/external partners.
• Provide case summaries and rationale; complete peer-to-peer consultations as required.
• Review Quality of Care concerns and assist with case summaries and next steps.
• Perform other duties as assigned.

Conhecimentos

Strong communication

Critical thinking

Decision making

Influential skills

Formação académica

Medical degree

Board certification preferred

Descrição da oferta de emprego

VNS Health is seeking a physician to oversee utilization management for its New York members. You will provide medical determinations, consult on coverage decisions, and ensure timely, guideline-based patient care.

Collaboration with internal teams and external partners is essential. The role requires medical licensure in the state, board certification in Internal or Family Medicine preferred, and a track record in managed care.