[Hiring] Physician @Diversified Systems

Role Description

Diversified Systems is searching for Medical Review Professional Physicians to perform reviews of external medical review requests and prior authorization requests involving medical necessity, resource utilization, standards of care, quality of care, and related clinical issues. The selected physicians will provide reasoned clinical opinions and respond to specific medical questions presented as part of the review process. Physician reviewers may receive expedited External Medical Review (EMR) requests requiring turnaround times of less than three business days.

Responsibilities

• Perform reviews of external medical review requests.
• Perform reviews of prior authorization requests.
• Evaluate issues related to medical necessity, resource utilization, standards of care, and overall quality of care.
• Provide reasoned clinical opinions and recommendations.
• Respond to specific clinical questions associated with review requests.
• Support expedited External Medical Review (EMR) requests as assigned.

Requirements

• Current unrestricted Ohio medical license required.
• Must be licensed as a Doctor of Medicine (MD), Doctor of Osteopathic Medicine (DO), or Doctor of Podiatric Medicine (DPM) in the United States with an unencumbered license required.
• 5+ years of experience in specialty field of medicine required.
• Must have actively practiced within specialty field during the past 12 months providing direct patient care required.
• Board certification in specialty field required. Physician must provide a copy of board certification(s).
• No history of sanctions or disciplinary actions required.
• No loss of personnel privileges or restrictions on participation required.

Prior Authorization Specialty Needed

• Internal Medicine.

External Medical Review (EMR) Specialties Needed

• Orthopedic Surgery.
• Physical Medicine and Rehabilitation (PM&R).
• Pain Medicine.
• Addiction Medicine.
• Neurology.
• Neurosurgery.
• Cardiology.
• Adult Psychiatry.
• Child Psychiatry (specialized in ABA).
• Oncology.
• Pediatrics.
• Ophthalmology.

Desired Skills

• Previous Prior Authorization review experience preferred.