Utilization Management Review - Full-Time & Part-Time (REMOTE) Physician Opportunities!

Doctor's Choice Placement Services, Inc; Miami (FL); Remote; USD 150,000 - 250,000; Full time

Job summary

An established industry player is seeking experienced physicians to join their innovative team in a fully remote role. This position focuses on delivering high-quality medical reviews in Orthopedic Surgery, Neurosurgery, Pain Management, or Primary Care Sports Medicine. You will play a crucial role in ensuring that clinical decisions are based on evidence-based guidelines while collaborating with a diverse team. The company is dedicated to enhancing the healthcare experience for patients and providers alike. If you're passionate about making a difference in healthcare and thrive in a fast-paced environment, this opportunity is perfect for you.

Benefits

Medical Insurance

Dental Insurance

Vision Insurance

Paid Time Off

Disability Coverage

Qualifications

• 5+ years of clinical practice in Orthopedic Surgery or related fields.
• Completed residency/fellowship and board certification required.

Responsibilities

• Provide timely medical reviews and clinical determinations.
• Document communication and decision-making accurately.

Skills

Orthopedic Surgery

Neurosurgery

Pain Management

Primary Care Sports Medicine

Clinical Review

Communication Skills

Multitasking

Education

US-based residency/fellowship program

Board certification as MD or DO

Tools

Workflow tools

Job description

100% Remote positions - No Office, No Hospital work! Great schedule/quality of life!

Competitive Base Salary (To be discussed directly with the company). Full benefits package includes Medical, Dental, Vision, Paid time off and Disability coverages, etc.

Company Overview:
Company is illuminating healthcare for patients, their doctors, and all those who are important in a patient’s healthcare experience, both in and out of the doctor’s office. Founded in August 2019, we are obsessed with eliminating wasteful friction that patients and doctors experience in areas that have nothing to do with health and treatment, particularly for diagnoses that require expensive procedures or medications. To that end, we build software that is expressly designed to ensure the appropriate plan of care is understood and expeditiously approved, so that patients and doctors can focus on health, rather than payment or administrative hassles.

Opportunity Overview:
We are looking for physicians who have expertise in Orthopedic Surgery, Spine Surgery, Neurosurgery, Pain Management, or Primary Care Sports Medicine to deliver on our musculoskeletal and orthopedic programs by determining the medical appropriateness of services by reviewing clinical information and applying evidence-based guidelines.
Reporting to the Senior Medical Director and part of the review team that includes non-clinical intake specialists and nurses, this is a critical role in a Series B company that is rapidly scaling to impact millions of patients. This is a fast-paced environment that favors people who are able to learn quickly, be hands-on, handle ambiguity, and communicate effectively with people of different backgrounds and perspectives.

What You Will Do:

1. Provide timely medical reviews that meet our stringent quality parameters.
2. Provide clinical determinations based on evidence-based criteria while utilizing clinical acumen.
3. Clearly and accurately document all communication and decision-making in workflow tools, ensuring a member and provider can easily reference and understand your decision.
4. Use correct templates for documenting decisions during case review.
5. Meet the appropriate turn-around times for clinical reviews.
6. Conduct timely peer-to-peer discussions with treating providers to clarify clinical information and to explain review outcome decisions, including feedback on alternate treatment based on medical necessity criteria and evidence-based research.
7. Demonstrate the highest level of professionalism, accountability, and service in your interactions with teammates and providers.
8. Support projects specific to building the team's clinical expertise and efficiency, as delegated.
9. Support the team on operational improvements and member/provider experience involving clinical review tasks, as delegated.

Your Background and Requirements:

Required:

1. Completed US-based residency/fellowship program in Orthopedic Surgery, Neurosurgery, Pain Management, or Primary Care Sports Medicine.
2. Board certification as an MD or DO with a current unrestricted state license to practice medicine - reviewers must maintain necessary credentials to retain the position.
3. 5+ years of clinical practice beyond residency/fellowship in Orthopedic Surgery, Neurosurgery, Pain Management, or Primary Care Sports Medicine.

Preferred (but NOT required):

1. 1+ years of managed care utilization review experience.
2. Membership in national and/or regional specialty societies.
3. Licensure in AZ, GA, MS, NC, ND, OK, OR, or TX is highly desirable - you should be willing to obtain additional state licenses with company's support.

Competencies/Success Factors:

1. Able to multitask and manage tasks to completion on a timely basis and in an organized fashion.
2. Excels in a matrix organization.
3. Excellent communication - written and spoken.
4. Comfortable with technology - willing and able to learn new software tools.
5. Understanding of managed care regulatory structure and processes.
6. Detail-oriented, flexible, and able to work autonomously with little supervision.

We can’t wait to learn more about you and meet you!

Equal Opportunity Statement:
We are an Equal Opportunity Employer. We are committed to fostering an environment of mutual respect where equal employment opportunities are available to all. To us, it’s personal.