Physician Reviewer (ks591-ah)
Physician - Non-Direct Care | Chicago, IL | Full Time and Temporary
Remote Position (IL License)
We are currently seeking to find a Physician Reviewer for a contract opportunity. The contract will last until the end of the year, possibly longer.
Our client has a well-known reputation for being a great place to work and have been recognized with awards many times by various organizations. The company fosters a team-oriented environment where both managers and team members support their colleagues. This is a great opportunity to work in a non-direct patient care role. The hours are 8-5 Mon-Fri but there is usually flexibility in the start time (as late as 9:30 am). Must be available to work 8 hours per day, 5 days per week.
In a nutshell, our client is seeking a Physician (M.D./D.O.) with solid experience working as a Primary Care Physician. This is a 100% remote opportunity but candidate must hold an M.D. or D.O. license in the state of Illinois.
- Uses clinical judgment in conjunction with organization's criteria to adjudicate these requests. May also provide clinical leadership in other areas of the organization.
- Identifies opportunities to manage members' clinical situations with a view toward creative problem solving and anticipation of possible future clinical problems for the member.
- Participates in the process to evaluate clinical service requests.
- Practices anticipatory case management for members whose cases come for review, in partnership with case managers.
- Participates in the Physician Review Units' appeal process of service denials.
- Participates in the development of Physician Review Units' policies and procedures.
- Actively participates in all unit continuous quality improvement activities.
- Board Certified (ABMS) M.D. or D.O, unrestricted and active license to practice medicine requested
- 5 years clinical experience to include inpatient experience, or any combination of education/experience that would provide an equivalent background.
- Must understand managed care and demonstrate PC proficiency, as file review will be done via computer in most cases.
(Note: Position does not provide direct patient care or medical diagnosis)
We support a diverse workforce and is an Equal Opportunity Employer who does not discriminate against employees and applicants for employment on the basis of race, gender, color, religion, national origin, age, sexual orientation, gender identity, genetic information, disability, veteran status, or other classification protected by law.