We are hiring several Physician Reviewers in CA for the largest, locally-based commercial health plan in San Diego. They provide their members to an award-winning network of hospitals, medical groups and physicians.
This is an opportunity to push for better patient outcomes and determine medical necessity of care.
The Physician Reviewer will perform all reasonably necessary functions to ensure quality of care and appropriate utilization in the most cost-effective, appropriate and professional manner, which meets the expressed needs of patients and professional colleagues.
The Physician Reviewer will be a part of the Health Services Department. This department is comprised of areas of Medical Management, Provider Relations/Network Support, Quality Improvement and Pharmacy.
- M.D. Degree
- License to practice in California must be in progress prior to start date
- Five years experience as a practicing primary care physician with knowledge of managed care and the process for prior authorization review
- Knowledge of physician social and political behavior and managed care philosophy
- Effective communication skills
- Ability to work collaboratively with medical leadership and administration of Health Plan, medical staff, nurses, and hospital administration.
- Board Certification in Internal Medicine or Family Medicine
This is a Monday - Friday regular office hours with no call or weekend work.