Senior Physician Reviewer, Utilization Management

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

Benefits offered by this job

Employee benefits

Job summary

ChenMed seeks a Physician Reviewer to lead Delegated Utilization Management across multiple markets. You will participate in health plan calls, coordinate patient care with local teams, and contribute to process improvements in the rapidly expanding UM function.

Requirements include an unrestricted medical license, residency in Internal Medicine or Family Practice, and Rheumatology board certification. Hospital medicine and utilization review experience are 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 Rheumatology.
• Two (2) years’ experience in Hospital medicine preferred.
• At least one (1) year of utilization review experience preferred.

Responsibilities

• Provides Delegated UM by covering the specified territories as assigned: establishes 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.

Skills

Analytical skills

Judgement

Communication

Organization

English fluency

MS Office

Education

Medical degree

Internal Medicine residency

Rheumatology board certification

Hospital medicine experience

Utilization review experience

Job description

ChenMed seeks a Physician Reviewer to lead Delegated Utilization Management across multiple markets. You will participate in health plan calls, coordinate patient care with local teams, and contribute to process improvements in the rapidly expanding UM function.

Requirements include an unrestricted medical license, residency in Internal Medicine or Family Practice, and Rheumatology board certification. Hospital medicine and utilization review experience are preferred.