Remote Physician Reviewer 30182 Position Available In Fulton, Georgia
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Job Description
Job Description:
One of the largest health insurers in the nation is focused oncontinuously building an industry-defining, world-class ITcapability. Healthcare is forever evolving, especially due toemerging technologies, making this a great experience to add toyour resume. Come join their winning team! This contract role as aRemote Physician Reviewer is responsible for evaluating clinicalservice requests made by an organization’s members and providers.
Pay Rate:
$105 per hour
Responsibilities:
- Evaluates clinicalservice requests made by an organization’s members and providers.
- Uses clinical judgment in conjunction with organization’s criteriato adjudicate these requests.
- Provide clinical leadership inother areas of the organization.
- Identify opportunities to managemembers’ clinical situations with a view toward creative problemsolving and anticipation of possible future clinical problems forthe member.
- Participate in the process to evaluate clinicalservice requests.
- Practice anticipatory case management formembers whose cases come for review, in partnership with casemanagers.
- Participate in the Physician Review Units’ appealprocess of service denials.
- Participate in the development ofPhysician Review Units’ policies and procedures.
- Activelyparticipates in all unit continuous quality improvement activities.
- Perform other duties as assigned by the Medical Director.
JobRequirements:
- Board Certified (ABMS) M.D. or D.O, unrestrictedand active license to practice medicine requested and 5 yearsclinical experience to include inpatient experience, or anycombination of education/experience that would provide anequivalent background.
- Must have understanding of managed careand demonstrate PC proficiency, as file review will be done viacomputer in most cases.
(
Note:
Position does not provide directpatient care or medical diagnosis.)
Preferred Job Requirements:
- 10 years clinical experience
- Experience with managed care andutilization management.
Benefits :
Solving IT, a Woman and LGBTQowned and operated organization is thrilled to provide acomprehensive benefit package to all our W2 employees and theirfamilies, regardless of gender. We are proud to offer five diversehealth plan options as well as a PPO dental plan through Blue CrossBlue Shield, Term Life/AD&D Insurance, and a 401(k) SavingsPlan. Solving IT covers a portion of the health and dental premiumsfor our employees. As you progress in your professional journey,Solving IT is dedicated to accommodating your evolving preferencesand matching you with fulfilling projects. We champion equality andembrace diversity in all its forms. Creating an atmosphere thatencourages varied perspectives to collaborate fosters personaldevelopment, strengthens team unity, and contributes to the overallsuccess of the organization! Whether you’re seeking your nextcareer challenge or aiming to stay abreast of industry trends,Solving IT is committed to supporting your career advancement. Weactively encourage applications from all backgrounds and utilizethe most up-to-date market insights and compensation data to ensurethat you receive not just advice, but the complete Solving ITExperience.