Pulmonology Physician Reviewer - Utilization & Quality

ChenMed; Miami (FL); On-site; USD 205,000 - 292,515; Full time

Job summary

ChenMed in the United States is seeking a Physician Reviewer to serve as the primary reviewer for Utilization Management (UM) cases. You will advise other physician reviewers and participate in daily calls with health plan teams to coordinate care for our patients.

This role contributes to Process and Quality improvement in Delegated UM, and includes establishing UM workflows and supporting multiple markets.

Qualifications

• Graduate from an accredited medical school with a valid, unrestricted license.
• Completion of Internal Medicine or Family Practice residency.
• Board certification in Pulmonology.
• Two years’ experience in Hospital medicine preferred.
• At least one year of utilization review experience preferred.

Responsibilities

• Provides Delegated UM by covering the specified territories and attends meetings and calls.
• Advises other physician reviewers.
• Other duties as assigned and modified by manager.

Skills

Analytical thinking

Deductive reasoning

Judgement

Communication skills

Organizational skills

English fluency

MS Office

Education

Medical degree from accredited medical school

Internal Medicine or Family Practice residency

Board Certification in Pulmonology

Hospital medicine experience

Utilization review experience

Job description

ChenMed in the United States is seeking a Physician Reviewer to serve as the primary reviewer for Utilization Management (UM) cases. You will advise other physician reviewers and participate in daily calls with health plan teams to coordinate care for our patients.

This role contributes to Process and Quality improvement in Delegated UM, and includes establishing UM workflows and supporting multiple markets.