Remote Physician Utilization Reviewer — Home Health

Partners In Recovery LLC

Phoenix (AZ)

Remote

USD 120,000 - 180,000

Full time

5 days ago

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Job summary

tango is a leader in the home health management industry and is preparing for significant growth! We partner with health plans to provide a comprehensive suite of products and services designed to manage the total cost of care.

We are currently looking for a Physician Reviewer to join our growing team on a full time basis. The Physician Reviewer provides real-time UM case reviews, peer-to-peer discussions and education across utilization management, provider relations, and clinical

Qualifications

MD or DO license in good standing with no restrictions in the state of UM reviews.
Board certified in primary care or related specialty preferred.
Active physician practicing with 10+ years of experience.

Responsibilities

Perform focused real-time case reviews using the software systems.
Apply medical judgement and evidence-based guidelines to determine medical necessity for home health services.
Review Potential Quality Issues (PQIs).
Provide quality reviews addressing member needs and compliant with guidelines and accreditation requirements.
Document areas of inappropriate utilization of resources.
Participate in inter-rater review cases and Peer-to-Peer discussions with payers and physicians.