PM&R Utilization Management Physician Reviewer

Santa Barbara Cottage Hospital; Atlanta (GA); Remote; USD 230,000 - 250,000; Full time

Job summary

A forward-thinking organization is seeking a PM&R Utilization Management Physician to ensure the effective use of medical resources while maintaining high standards of patient care. This role involves thorough reviews of utilization management cases, close collaboration with medical teams, and clear communication with clients. The ideal candidate will have a strong medical background, including an MD, DO, or DPM degree, and board certification in PM&R. Join a dynamic team dedicated to delivering quality healthcare solutions and enjoy competitive benefits in a fast-paced environment.

Benefits

Medical Insurance

Vision Insurance

Dental Insurance

Paid Time Off

401k Plan

Qualifications

• 5+ years of experience in medical practice required.
• Must have strong knowledge of medical terminology and procedures.

Responsibilities

• Perform utilization management reviews efficiently and accurately.
• Collaborate with Medical Directors and stakeholders regarding review outcomes.

Skills

Medical Practice

Utilization Management

Clinical Guidance

Medical Terminology

Education

MD, DO, or DPM degree

Board Certified in PM&R

Job description

Job Details

Atlanta, GA

Fully Remote

Full Time

$230000.00 - $250000.00 Salary/year

None

Description

Overview

The PM&R Utilization Management Physician will be responsible for providing thorough and accurate reviews of utilization management cases to ensure the appropriate use of medical resources while continuing to hold high standards of patient care. The position will involve collaborating closely with both the Medical Director, other team members, and clients to conduct reviews with a high level of accuracy and efficiency. This collaboration ensures that reviews are thorough, well documented, and align with established medical guidelines and standards.

Responsibilities

• Perform utilization management reviews in an efficient and timely manner, ensuring each review is completed with careful attention to detail while maintaining high quality work.
• Review appeals or complaints that relate to medical review decisions by conducting a thorough assessment of all medical records, treatment plans, and other supporting documents from healthcare providers.
• Collaborate with the Medical Director and Senior Management to ensure effective coordination of the delivery of services to clients.
• Communicate with client Medical Directors and other stakeholders regarding the utilization management process; provide detailed explanation of review outcomes, address questions and concerns and ensure all parties are aware of any changes or updates in the process.
• Participate in the quality improvement of all steps in the review process.
• Act as a medical resource and provide guidance to Pharmacists and other team members regarding clinical questions.
• Communicate clearly and professionally with clients at regular meetings regarding quality and production.
• Audit cases and provide quality feedback as needed.
• Perform all other duties as assigned by management.

Qualifications

• MD, DO, or DPM degree required
• Current, active unrestricted license to practice medicine required.
• 5+ years of experience in medical practice required.
• Board certified in PM&R (Board Certified Physiatrist) required
• Ability to provide clinical guidance regarding the quality and/or clinical aspects of reviews and, when appropriate, directly communicates with reviewers, staff, and/or clients.
• Ability to travel as required.
• Ability to interact with clients as needed, either independently or as a participating member of a group discussion between service and client, regarding the clinical quality aspects of the medical reviews.
• Must be able to review cases and data thoroughly to ensure that all necessary information meets quality standards.
• Must have strong knowledge of medical terminology and procedures, which may include utilization reviews, quality-assurance services compliance, and claims analysis.
• Must have knowledge of federal and/or state legislative mandates (ERISA and/or state law).
• Must be able to work well under pressure and or stressful conditions.
• Must possess the ability to manage change, delays, or unexpected events appropriately.
• Must be able to maintain confidentiality.
• Ability to follow all company policies and procedures in effect at time of hire and as they may change or be added from time to time.

WHO WE ARE

AllMed provides clinical decision making and utilization management solutions to leading payer and provider organizations. We work closely with your team toward a shared vision of healthcare that delivers the highest quality, values patient experience, and ensures both appropriate care and utilization of health-related services.

Our solutions are developed and delivered by experts—they are thoughtfully designed to integrate seamlessly into your organization and help you deliver the right care to the right patients at the right time.

AllMed is an Equal Opportunity Employer and affords equal opportunity to all qualified applicants for all positions without regard to protected veteran status, qualified individuals with disabilities and all individuals without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age or any other status protected under local, state or federal laws.

AllMedoffers a fast-paced team atmosphere with competitive benefits (medical, vision, dental), paid time off, and 401k.

Equal Opportunity Employer - Minorities/Females/Disabled/Veterans

unrestricted license to practice medicine required.

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