Senior Physician Reviewer — Quality & Utilization Expert

L.A. Care; Los Angeles (CA); Sur place; USD 206 000 - 351 000; Plein temps

Avantages offerts par ce poste

457 (b) Retirement Plan

529 College Savings Plan

Résumé du poste

L.A. Care Health Plan in Los Angeles, CA is seeking a Physician Reviewer II to conduct medical reviews and provide clinical consultation under the Senior Medical Director. The role emphasizes leadership of physicians and collaboration across medical management programs.

Responsibilities include determinations for utilization management, prior authorizations, and reviews, with focus on quality and regulatory compliance. MD required with extensive experience in medical management is preferred.

Qualifications

• Proven leadership of physicians, nurses, and clinicians.
• Strong teamwork and collaborative problem-solving abilities.
• Excellent written and verbal communication and negotiation skills.

Responsabilités

• Conduct medical reviews and prepare determinations for utilization management and related processes.
• Provide clinical consultation to case management and staff.
• Review data to improve Medical Management programs and participate in IRR rounds and ICT rounds.

Connaissances

Leadership

Teamwork

Written/Verbal Communication

Negotiation

Consensus Building

Planning & Implementation

Collaborative Problem-Solving

Formation

Doctor of Medicine (M.D.)

Description du poste

L.A. Care Health Plan in Los Angeles, CA is seeking a Physician Reviewer II to conduct medical reviews and provide clinical consultation under the Senior Medical Director. The role emphasizes leadership of physicians and collaboration across medical management programs.

Responsibilities include determinations for utilization management, prior authorizations, and reviews, with focus on quality and regulatory compliance. MD required with extensive experience in medical management is preferred.