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 Orthopedic Surgery and Spine fellowship to support expansion needs for the musculoskeletal 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"
- 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
- 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.
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 firstname.lastname@example.org or email@example.com.