Currently looking for MDs with active licenses in the IL state and experienced in Internal Medicine, Primary Care or Family Medicine to fill openings for Medical Review Physicians with a company based in Chicago, IL. Interested candidates should be board certification by American Board of Medical Specialities and demonstrated knowledge of current practice standards in speciality.
Responsibilities of the Medical Review Physician
Requirements of the Medical Review Physician
- Perform physician-level case review, following initial nurse review, of high-tech diagnostic imaging, modalities.
- Determine medical necessity of requests using Medical Necessity Guidelines and client-specific health plan medical policy
- Conduct peer-to-peer discussions with ordering physicians, physician assistants, and nurse practitioners to provide education regarding established guidelines and accepted standards of care as they pertain to the use of diagnostic imaging studies, cardiac testing, specialty pharmacy and sleep management services.
- Suggest alternatives services to ordering providers when appropriate
- Document the pre-certification review in a complete, concise, and accurate manner in the pre-certification computer application
- Demonstrate and maintain current knowledge of modalities and new applications of known technologies for diagnostic imaging, cardiac services, specialty pharmacy and sleep management
- Current unrestricted medical license(s) as a Doctor of Medicine or Doctor of Osteopathic Medicine
- Board Certification by American Board of Medical Specialties
- Demonstrated knowledge of current practice standards in specialty
- Computer literacy with the ability to learn new applications
- Ability to multitask