Senior Physician Reviewer, Utilization Management

ChenMed; Miami (FL); On-site; USD 204,761 - 292,515; Full time

Job summary

ChenMed is seeking a Physician Reviewer to serve as the primary physician reviewer for Utilization Management (UM) cases across multiple markets from our Miami area offices. You will participate in daily health plan calls, lead case reviews and contribute to quality improvement in delegated UM processes.

The role requires board certification and an internal medicine or family practice residency, with hospital medicine experience preferred.

Qualifications

• Graduate from accredited Medical School with a valid, unrestricted license is required.
• Completion of Internal Medicine or Family Practice residency
• Board Certification in residency area - Otorhinolaryngology (ENT)

Responsibilities

• Provides Delegated Utilization Management by covering the specified territories.
• Establish 2-3 cases a day for each market covered; attends health plan and local calls; participates in PCP and SNF meetings.
• Advises other physician reviewers; performs other duties as assigned by manager.

Skills

Analytical skills

Deductive reasoning

Communication skills

Organizational skills

Written and verbal English

Education

Medical School degree (MD)

Residency in Internal Medicine or Family Practice

Board Certification in ENT (Otorhinolaryngology)

Tools

Microsoft Office

Job description

ChenMed is seeking a Physician Reviewer to serve as the primary physician reviewer for Utilization Management (UM) cases across multiple markets from our Miami area offices. You will participate in daily health plan calls, lead case reviews and contribute to quality improvement in delegated UM processes.

The role requires board certification and an internal medicine or family practice residency, with hospital medicine experience preferred.