Utilization Review Physician — Expert Medical Necessity & Compliance

Dane Street, LLC; United States; À distance; USD 200 000 - 250 000; Plein temps

Avantages offerts par ce poste

Generous Paid Time Off

Excellent benefits package

Competitive salary

Résumé du poste

A leading healthcare provider in the United States is seeking a Physician to provide utilization review services. The successful candidate will utilize clinical expertise to review medical records and ensure compliance with guidelines. This role includes reviewing prior authorizations and appeals, maintaining proper licensure, and tackling QA issues. Ideal candidates will have a minimum of five years of postgraduate experience and strong communication skills. We offer generous Paid Time Off, an excellent benefits package, and a competitive salary.

Qualifications

• Minimum five years of postgraduate experience.
• Experience in Utilization Management with criteria review utilizing standard practice guidelines.
• Medicaid/Medicare experience preferred.

Responsabilités

• Review requests for Prior Authorizations and Appeals.
• Provide responses in member friendly language using provided templates.
• Maintain proper credentialing and state licenses.
• Identify and respond to quality assurance issues.

Connaissances

Excellent communication skills

Critical thinking

Computer literacy

Time management

Formation

Board Certified M.D. or D.O.

Description du poste

A leading healthcare provider in the United States is seeking a Physician to provide utilization review services. The successful candidate will utilize clinical expertise to review medical records and ensure compliance with guidelines. This role includes reviewing prior authorizations and appeals, maintaining proper licensure, and tackling QA issues. Ideal candidates will have a minimum of five years of postgraduate experience and strong communication skills. We offer generous Paid Time Off, an excellent benefits package, and a competitive salary.