Remote Medicare Advantage UM Physician

SHPCA SCAN Health Plan; California; Híbrido; USD 207.000 - 276.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Base salary range: $150.00 to $200.00/

Mostly remote with monthly on-site HQs

401(k) with employer match

Descripción de la vacante

SCAN Health Plan in California seeks a temporary Medicare Advantage UM Physician to perform physician-level medical necessity reviews for prior authorizations and ongoing utilization management. The role ensures timely, evidence-based determinations and collaborates with RN reviewers and leadership.

You will conduct peer-to-peer discussions, support appeals, and maintain regulatory alignment with NCQA/URAC requirements while guiding a high-volume review team.

Formación

• Graduate of an accredited medical school with an active MD/DO license.
• Board certification in a relevant specialty and current, unrestricted medical license.
• Minimum 5 years of active clinical practice in Internal/Family/Emergency Medicine.

Responsabilidades

• Perform physician-level medical necessity reviews for prior authorization, concurrent, and retrospective cases.
• Render determinations per Medicare guidelines and evidence-based criteria with clear rationale.
• Lead peer discussions and participate in appeals and ALJ processes when required.
• Mentor RN reviewers and staff while ensuring timely and compliant reviews.

Conocimientos

Analytical skills

Communication skills

Regulatory knowledge

Clinical judgment

Educación

Graduate of an accredited medical school

Medical License (MD/DO)

Board certification in Internal/Family/Emergency Medicine

Herramientas

Electronic health records (EHR)

UM/clinical workflow platforms

MCG criteria knowledge

Descripción del empleo

SCAN Health Plan in California seeks a temporary Medicare Advantage UM Physician to perform physician-level medical necessity reviews for prior authorizations and ongoing utilization management. The role ensures timely, evidence-based determinations and collaborates with RN reviewers and leadership.

You will conduct peer-to-peer discussions, support appeals, and maintain regulatory alignment with NCQA/URAC requirements while guiding a high-volume review team.