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Physician Reviewer - Home Based

Chicago, Illinois
The right candidate will have, demonstrable on the resume, a current unrestricted medical license as a Doctor of Medicine (MD) or Doctor of Osteopathic (DO) in Illinois. You must have certification by the American Board of Medical Specialties. You must have demonstrated knowledge of your current practice, and possess strong oral communication and interpersonal skills. You'll be computer literate with the ability to learn new applications. This position REQUIRES that you live in or near Chicago. If you don't now, you must be willing to move there.

Our client is seeking General Practitioners, Pediatricians, Family Medicine, Radiology and Medical Oncology physicians who are interested in transitioning to a non-patient-facing clinical environment. Both part-time and full-time opportunities exist for these roles.  You'll be required to be in the office 5 days a week for the first 6 weeks to be trained in the system. Based on our client's comfort level, you may be transitioned out to a home office base.

You will conduct office-based pre-authorization of high-tech diagnostic imaging, cardiac testing, specialty pharmacy and sleep management services, and determine the medical necessity of outpatient requests using clinical guidelines and health plan medical policy. You will perform physician-level case review, following initial nurse review, of high-tech diagnostic imaging and other modalities. Imaging modalities may include CT, CTA, MRI, MRA, PET, and Nuclear Cardiology.

Using your experience, you will determine the medical necessity of requests using our client's Medical Necessity Guidelines and client-specific health plan medical policy, suggesting alternative services to ordering providers when appropriate.
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