[Hiring] Medical Reviewer @Community Health Network of Connecticut, Inc.

Role Description

Community Health Network of Connecticut, Inc. (CHNCT) is currently seeking a Medical Reviewer.

• Under the general direction of the Vice President of Clinical Affairs, performs medical case review of services subject to approval under the Connecticut Medical Assistance Program (CMAP).
• Participates and contributes actively in medical matters related to:
  • Utilization management
  • Case management
  • Peer review
  • Quality improvement
  • Other processes requiring medical/clinical leadership and consultation
• Responds to inquiries from providers, internal stakeholders, and Department of Social Services as necessary.
• Serves as a resource to CHNCT clinical staff.
• Provides recommendations for improving care delivery and health outcomes for CMAP enrollees.
• Participates in activities specific to contractual requirements such as Fair Hearings, etc.

Qualifications

• Medical School
• Desired Degree: Medical Doctor or Doctor of Osteopathy
• Desired Major: Primary care specialty

Requirements

• Minimum 2 years as a Medical Reviewer or physician consultant in a managed care company preferred.
• Experience in Utilization Management, Case and Disease Management, preferably with Medicaid populations.
• Clinical experience in managing a range of pathologies and populations.
• Up-to-date knowledge of evidence-based medical guidelines and accepted standards of care for managing the treatments, procedures, conditions, and diseases under review by CHNCT.
• M.D. or D.O. current, non-restricted Connecticut license and Board certification.
• Flexible and able to adapt to altered work processes, technologies, and directives.

Benefits

• Medical, dental and vision coverage options
• Flexible spending and health savings accounts
• Group term life insurance
• A 401(k) plan with company-match and immediate vesting
• Voluntary accidental injury coverage
• Tuition reimbursement and continuing education opportunities
• A generous paid-leave bank and company holidays
• Wellness program