[Hiring] Licensed Physician Reviewer - Orthopedics @ChenMed

Role Description

The Physician Reviewer is the primary physician reviewer for Utilization Management (UM) cases in our organization. Other duties include:

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

ESSENTIAL JOB DUTIES/RESPONSIBILITIES:

• Provides Delegated UM by covering 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.
• Board Certification in residency area - Orthopedics.
• 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.

Pay Range

$204,761 - $292,515 Salary. The posted pay range represents the base hourly rate or base annual full-time salary for this position. Final compensation will depend on a variety of factors including but not limited to experience, education, geographic location, and other relevant factors. This position may also be eligible for bonuses or commissions.