Physician Review Operations & Training

Overview

The coordinator — Physician Review Operations & Training serves as a key operational liaison supporting physician review activities and ensuring consistent adherence to system workflows, training standards, and performance expectations. This role functions as the trainer, supporting physician reviewers through onboarding, ongoing education, scheduling coordination, and performance monitoring.
The coordinator works closely with both internal stakeholders and Customer partners to ensure efficient operations, compliance with established processes, and successful execution of physician review programs.

Key Responsibilities

Training & System Support

• Serve as the trainer, providing onboarding and ongoing training to physician reviewers on system functionality, workflows, and documentation requirements.
• Support adoption of system updates, workflow changes, and best practices through structured training and coaching.
• Monitor completion of Customer-assigned training requirements and follow up to ensure compliance.
• Act as a primary point of contact for physician reviewers regarding system functionality and process questions.

Operational Coordination

• Support scheduling coordination for physician review activities to ensure adequate coverage and timely completion of assigned work.
• Coordinate with Customer stakeholders and internal leadership regarding operational or performance-related matters.
• Assist in managing communication between physician reviewers, Customer representatives, and Company leadership.

Documentation & Compliance Oversight

• Perform documentation reviews to ensure physician reviews meet required quality standards and adhere to established system workflows and processes.
• Monitor system process adherence and identify opportunities for improvement or additional training.
• Escalate compliance or workflow concerns as appropriate.

Performance Monitoring & Reporting

• Review physician performance reports provided by the Customer or available within Customer systems.
• Track performance trends and support leadership in identifying coaching or corrective action opportunities.
• Assist with performance improvement initiatives as needed.

User Access & IT Coordination

• Coordinate new user system access setup with Customer IT teams.
• Manage deactivation of system access when required to ensure security and compliance standards are maintained.

Knowledge, Skills & Abilities:

• Strong understanding of UM workflows including prior authorization, concurrent review, and appeals.
• Knowledge of regulatory requirements and accreditation standards (NCQA preferred).
• Excellent presentation and facilitation skills.
• Strong analytical and critical-thinking abilities.
• Ability to interpret clinical documentation and medical policy.
• Excellent written and verbal communication skills.
• Proficiency with UM systems and Microsoft Office applications.
• Strong organizational skills and ability to manage multiple priorities.

Qualifications:

• Bachelor’s or Master’s degree in Nursing, Healthcare Administration, Public Health, or related field required.
• Clinical (active and unrestricted) licensure (e.g., RN) required.
• 5–10+ years of experience in a clinical setting.
• 5+ years of experience in health plan Utilization management.
• 2+ years of experience in training, auditing, quality assurance and/or education role.
• Experience with healthcare technology (e.g., EHR systems like Epic or Cerner, clinical decision support).
• Deep knowledge of healthcare regulations (e.g., CMS, HIPAA, Joint Commission) and clinical quality programs.
• Strong analytical, communication, and stakeholder engagement skills.
• Strong knowledge of NCQA standards, CMS guidelines, and state/federal regulations.
• Experience with medical necessity criteria tools (InterQual, MCG, or similar).

Preferred Qualifications:

• Prior audit experience within a managed care or health plan setting preferred.
• Experience with value-based care models, ACOs, or population health strategies.
• Certification in Lean Six Sigma, PMP, or healthcare quality (e.g., CPHQ).

Core Competencies

• Training and facilitation skills
• Attention to detail and compliance focus
• Stakeholder collaboration
• Process improvement mindset
• Strong organizational and follow-through abilities

Pay: $60,534.39 - $72,901.63 per year

Experience:

• Utilization management: 5 years (Preferred)
• training: 2 years (Required)
• auditing: 2 years (Required)

License/Certification:

• RN License (Required)

Work Location: Remote