Remote Physician Reviewer — Medicare Utilization Management

Solving IT; United States; Remote; USD 120,000 - 170,000; Full time

Benefits offered by this job

Five diverse health plan options

PPO dental plan

Term Life/AD&D Insurance

401(k) Savings Plan

Job summary

A healthcare management organization is seeking experienced Physician Reviewers to join their Medicare Utilization Management team in a remote position. Responsibilities include reviewing clinical service requests, applying evidence-based guidelines, and collaborating to ensure quality care for members. Candidates must be board-certified physicians with a minimum of 5 years of clinical experience. A comprehensive benefits package including health plans and 401(k) is offered, promoting equality and diversity in the workplace.

Qualifications

• 5+ years of post-residency clinical experience, including inpatient care.
• Understanding of managed care principles.
• Internal Medicine specialization preferred.

Responsibilities

• Review clinical service requests using clinical judgment.
• Identify opportunities to proactively manage members’ clinical situations.
• Conduct peer-to-peer discussions with treating physicians as needed.

Skills

Board Certification (ABMS)

Strong communication skills

Teamwork skills

Proficiency with computer-based case review systems

Education

M.D. or D.O. with active medical license

Tools

MHK utilization management platform

Job description

A healthcare management organization is seeking experienced Physician Reviewers to join their Medicare Utilization Management team in a remote position. Responsibilities include reviewing clinical service requests, applying evidence-based guidelines, and collaborating to ensure quality care for members. Candidates must be board-certified physicians with a minimum of 5 years of clinical experience. A comprehensive benefits package including health plans and 401(k) is offered, promoting equality and diversity in the workplace.