$200K — $250K *
- 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 necessary credentials and immediately informs eviCore of any adverse actions relating to medical licenses and/or board certifications.
- Participates in strategic planning for and evaluation of the Care Management process/unit.
- The successful candidate will be an M.D. or D.O. with a current, active, U.S. state medical license and board certified in Gastroenterology, recognized by the American Board of Medical Specialties (ABMS), or American Osteopathic Association (AOA)
- Recent practice experience in direct patient care (within the past 18 months).
- Must have a minimum of 5 years clinical experience, beyond residency/fellowship
- 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
This position is not eligible to be performed in Colorado.
Valid through: 6/19/2021
$150K — $200K *
11 days ago