Work From Home - $250K Per Year

CA

Posted: 08/19/19 Employment Type: Full Time Specialty: Family Practice Job Number: FP 3182 Pay Rate: $250k - 300k per year
Physician Reviewer of Utilization Management will provide routine review of authorization requests from all lines of business using respective national/state, health plan, nationally recognized guidelines where appropriate to provide guidance for processing of referrals to Medical Director staff and to UM staff.

NON-Negotiable Requirements

* CA Physician License in good standing
* 3+ years of Health Plan or IPA experience doing UM Authorization Reviews
* 3+ years of experience decisioning cases using Medi-Cal and Medicare guidelines
* 3+ years of experience using InterQual or MCG

Job Duties:

- Approve or Deny authorizations

- Review claims for outpatient authorization, inpatient authorizations, and Emergency Room claims.

- Physician Reviewers may provide oversight, guidance, and training sessions

- Responsible for the daily review and processing of referral authorizations in accordance to turnaround time (TAT) standards set by ICE/Health Plan

- Monitors ongoing services and their cost effectiveness; recommending changes to the plan as needed using clinical evidence-based criteria - Milliman, Interqual, CMS, National Recognized American Academy of Specific Specialty, Health Plan specific criteria.

Casey Galpin

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