Senior Physician Reviewer — Utilization Management

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

Job summary

ChenMed is hiring a Physician Reviewer for Utilization Management to oversee delegated UM cases across multiple markets, supporting health plan calls and local teams. You will participate in care coordination and contribute to ongoing quality initiatives within our expanding organization.

The role requires a medical degree, Internal Medicine or Family Practice residency completion, and board certification in Infectious Disease, with preferred hours and responsibilities centered on improving

Qualifications

• Graduate from accredited medical school with an unrestricted license.

Responsibilities

• Provides Delegated UM by covering the specified territories: establish 2-3 cases daily (up to 6 markets); attend health plan and local calls; attend PCP and SNF meetings.
• Advises other physician reviewers.
• Other duties as assigned and modified by manager.

Skills

Analytical skills

Communication skills

Organizational skills

English fluency

Problem solving

MS Office proficiency

Education

Medical degree (MD)

Internal Medicine residency

Family Medicine residency

Board certification in Infectious Disease

Tools

MS Office

Job description

We’re unique. You should be, too.

We’re changing lives every day. For both our patients and our team members. Are you innovative and entrepreneurial minded? Is your work ethic and ambition off the charts? Do you inspire others with your kindness and joy?

We’re unique. You should be, too.

We’re changing lives every day. For both our patients and our team members. Are you innovative and entrepreneurial minded? Is your work ethic and ambition off the charts? Do you inspire others with your kindness and joy?

We’re different than most primary care providers. We’re rapidly expanding and we need great people to join our team.

The Physician Reviewer is the primary physician reviewer for Utilization Management (UM) cases in our organization. Other duties include advising other physician reviewers and attending daily calls with health plan teams and our local teams assisting with this function and coordinating care for our patients. The position will also participate in Process and Quality improvement in our developing area of Delegated Utilization Management.

Essential Job Duties/Responsibilities

• Provides Delegated UM by covering the specified territories as assigned:
• Establish 2-3 cases a day for each market covered (up to 6 markets); ensures attendance on all health plan and local calls; calls in for the weekly Primary Care Provider (PCP) and Skilled Nursing Facility (SNF) meetings covering the assigned territories.
• Advises other physician reviewers.
• Other duties as assigned and modified by manager.
  

Knowledge, Skills And Abilities

• Excellent analytical and deductive reasoning skills
• Good judgement and problem-solving skills
• Professional and effective communication skills
• Strong organizational skills
• Written and verbal fluency in English
• Proficient in the use of Microsoft Office products such as Outlook, Excel, Word and PowerPoint
  
  

Education And Experience Criteria

• Graduate from accredited Medical School with a valid, unrestricted license is required
• Completion of Internal Medicine or Family Practice residency
• Board Certification in Infectious Disease
• Two (2) years’ experience in Hospital medicine preferred
• At least one (1) year of utilization review experience preferred
  
  

Pay Range

$204,761 - $292,515 Salary

The posted pay range represents the base hourly rate or base annual full-time salary for this position. Final compensation will depend on a variety of factors including but not limited to experience, education, geographic location, and other relevant factors. This position may also be eligible for a bonuses or commissions.

Employee Benefits

https://chenmed.makeityoursource.com/helpful-documents

We’re ChenMed and we’re transforming healthcare for seniors and changing America’s healthcare for the better. Family-owned and physician-led, our unique approach allows us to improve the health and well-being of the populations we serve. We’re growing rapidly as we seek to rescue more and more seniors from inadequate health care.

ChenMed is changing lives for the people we serve and the people we hire. With great compensation, comprehensive benefits, career development and advancement opportunities and so much more, our employees enjoy great work-life balance and opportunities to grow. Join our team who make a difference in people’s lives every single day.

Current employees, if you want to apply to our internal career site, please click HERE

Current Contingent Worker please see job aid HERE to apply