[Hiring] Licensed Physician Reviewer - Neurology @ChenMed

Role Description

The Physician Reviewer is the primary physician reviewer for Clinical Appropriateness Reviews cases in our organization. Other duties include:

• Advising other physician reviewers.
• Attending daily calls with health plan teams and local teams assisting with this function.
• Coordinating care for our patients.
• Participating in Process and Quality improvement in the area of Delegated Utilization Management.

Essential Job Duties/Responsibilities:

• Provides Clinical Appropriateness Reviews by covering the specified territories as assigned.
• Establishes 2-3 cases a day for each market covered (up to 6 markets).
• Ensures attendance on all health plan and local calls.
• Calls in for the weekly Primary Care Provider (PCP) and Skilled Nursing Facility (SNF) meetings covering the assigned territories.
• Other duties as assigned and modified by manager.

Qualifications

• Excellent analytical and deductive reasoning skills.
• Good judgement and problem-solving skills.
• Professional and effective communication skills.
• Strong organizational skills.
• Written and verbal fluency in English.
• Proficient in the use of Microsoft Office products such as Outlook, Excel, Word, and PowerPoint.

Requirements

• Graduate from accredited Medical School with a valid, unrestricted license is required.
• Completion of Internal Medicine or Family Practice residency.
• Completion of Fellowship in Neurology.
• Board Certification in residency area.
• Board Certified in Neurology.
• Two (2) years’ experience in Hospital medicine preferred.
• At least one (1) year of utilization review experience preferred.

Benefits

• Great compensation.
• Comprehensive benefits.
• Career development and advancement opportunities.
• Great work-life balance.
• Opportunities to grow.