Seeking experienced clinical practitioners in IL OR CA, who would like to transition to a non-patient-facing clinical environment.
• Join one of the fastest growing non-clinical careers - "become a Peer Review Advisor"
• Join a team of over 600 licensed and board-certified practitioners to advocate for quality of health care using evidence-based medicine data
• Part Time available for certain specialties Our client:
• Provides innovative clinical solutions that focus on today's most complex and costly tests and treatments in radiology, cardiology, medical and radiation oncology, specialty drugs, sleep medicine, musculoskeletal and pain management, genetic testing, palliative care, and other emerging clinical areas
• Our client is certified by (NCQA) and has received Full Accreditation for Health Utilization Management from(URAC) About the Opportunity: • Physician Reviewers determine the medical necessity of outpatient requests using clinical guidelines and health plan medical policy • You will Participate in periodic physician reviewer meetings
• Demonstrate and maintain knowledge of relevant policies and regulations pertaining to utilization review of diagnostic imaging procedures, cardiac services, specialty pharmacy, radiation therapy, and sleep management. Acquire, demonstrate, and maintain proficiency with ICD-10 and CPT coding
• Participate on committees or in work groups as needed for revision of clinical guidelines and/or serve as a subject matter expert
• Perform first level provider appeals as designated by the client for adverse determinations
• Hold an active, unrestricted license in IL or CA (compact licenses are acceptable). MA license a plus
• At least 4+ years experience after fellowship training preferred
• Board Certified
• Trained in: Internal Medicine, Family Practice, Primary care, Sleep Medicine, Pain and Anesthesiology, Cardiology, Radiation Oncology, Hematology/Oncology, Orthopedic Surgery, and Neurologic Surgery