100% Remote opportunity to conduct utilization management - chart reviews for a brand name specialty benefits company. 

We are seeking several physicians with a board certification in Medical Oncology/Hematology to support expansion needs for the Oncology specialty.


- No long commutes to an office
- flexible schedules including weekend hours available
- part time or full time opportunities open
- Work from the comfort of your home office
-  Impact care within a growing MSK specialty
-  All State licenses welcome
- Must be proficient using Windows
- Must be willing to train "on the job" 

Minimum Requirements:               

• The successful candidate will be an M.D. or D.O. with a current, active, U.S. state medical license and board certified in a specialty recognized by the American Board of Medical Specialties (ABMS), with recent practice experience in direct patient care (within the past 18 months). 
• Knowledge of applicable state and federal laws, URAC and NCQA standards a plus, and familiarity with automated processes and computer applications and systems is required

Responsibilities:

• Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States.
• Reviews appeals for denied services related to current relevant medical experience or knowledge in accordance with appeal policies, if so delegated.
• Provides timely peer-to-peer discussions with referring physicians to clarify clinical information and to explain review outcome decisions.
• Documents all actions related to clinical review sessions and attests to appeal review qualifications as required.
• Maintains files of all reviews as required by law and Health Plans to retrieve reportable data.
• Maintains necessary credentials and immediately informs eviCore of any adverse actions relating to medical licenses and/or board certifications.
• Supports the annual review of utilization review criteria.
• Supports and communicates policy and procedures to the provider community.
• Participates in strategic planning for and evaluation of the Care Management process/unit.
• Assists with staff educational training and in-service programs and serves as a clinical resource for  staff.

Our client  is committed to making a positive impact on healthcare, and also making a positive impact on our employees. This role offers a variety of perks and benefits including, but not limited to:

• Flexible scheduling and work/life balance with remote and work from home opportunities
• 4 weeks of PTO(starting) per year plus paid holidays
• Education assistance, tuition reimbursement and professional certifications
• Health, dental, vision, and life benefits with employer funded HSA
• Comprehensive employee discount program, onsite fitness facilities, and smart casual dress code
• Paid Volunteer Community Service Days
• Ample opportunities for growth, advancement, and promotion
• 401k retirement plan with company match of 50% employee contributions up to 6%  

 If interested, please send resume to skumar@maxpopuli.com or skumar@medpopuli.com.