utilization review physician

MedStar Health

<div>About this Job:
<div><div><b>
Physician Advisor &ndash; MedStar Washington Hospital Center</b></div><div></div><div><br>
MedStar Health is seeking a Physician Advisor to join our team at MedStar Washington Hospital Center in Washington DC. The Physician Advisor is an essential part of the team, using medical expertise to optimize resource use, reduce length of stay, and prevent clinical denials. Their work ensures patients receive appropriate, timely care. This will be a hybrid role.</div><div></div><div><b><br>
In this role, you&rsquo;ll:</b></div><ul><li>
Review patient status, medical necessity, and level of care</li><li>
Lead clinical denial interventions, denial root cause determinations and upstream process improvement initiatives.</li><li>
Engage in concurrent and retrospective denials management and peer to peer discussions with payers</li><li>
Drive length of stay improvements in close collaboration with case management and hospital stakeholders</li><li>
Provide education to physicians and other clinicians related to regulatory requirements, appropriate utilization of hospital services, community resources, and alternative level of care</li><li>
Participate in Interdisciplinary Rounds (IDR) with the Healthcare Team as indicated.</li><li>
Ensure regulatory compliance of Utilization Management and Discharge planning processes</li></ul><div><b>
At MedStar Health, you can expect:</b></div><ul><li>
A competitive salary</li><li>
Medical, dental, and vision insurance</li><li>
Paid malpractice insurance</li><li>
Paid Time Off</li><li>
Retirement plan</li></ul><div><b>
Education/Training:</b></div><ul><li>
Doctor of Medicine (M.D.) or Doctor of Osteopathic Medicine (D.O.) &ndash; <i>Board Certification required (Internal Medicine or Emergency Medicine preferred)</i></li><li>
Preferred: Additional certification in healthcare administration, business, or physician advisory</li></ul><div><b>
Experience:</b></div><ul><li>
Minimum 5 years of direct clinical practice required, hospital based experience preferred</li><li>
Previous experience as physician advisor preferred</li><li>
Strong knowledge of case management, utilization review, regulatory standards, denials management, observation medicine, and length of stay</li><li>
Familiarity with MCG and InterQual clinical criteria</li></ul><div><b>
Licensure/Certification:</b></div><ul><li>
Current medical license in the practicing state</li><li>
Board Certified</li><li>
Preferred: ACPA-C or ABQUARP certification in Physician Advisory (or willingness to obtain within 1 year of hire)</li></ul></div>
This position has a hiring range of : USD $250,000.00 - USD $350,000.00 /Yr.</div>

Physician Advisor - MedStar Washington Hospital Center

Dane Street

<div><p>As a Physician Reviewer/Advisor, you will utilize clinical expertise and review insurance appeals, prospective and retrospective claims. The Physician Reviewer will provide an interpretation of the medical necessity of services provided by other healthcare professionals in compliance with client-specific policies, nationally recognized evidence-based guidelines, and standards of care.</p><p></p><p><b>
MAJOR DUTIES AND RESPONSIBILITIES:</b></p><ul><li><ul>
<li>
Reviews all medical records and addresses each question posed by the client utilizing client specific criteria or other nationally recognized evidence-based criteria</li>
<li>Ensures that the rationale for the determination is clear, concise, and contains adequate supporting documentation to substantiate the decision</li>
<li>Identifies, critiques, and utilizes current criteria and resources such as national, state, and professional association guidelines and peer-reviewed literature that support sound and objective decision-making and rationales in reviews; refrains from using case studies, cohorts, and the like to make decisions due to their limited sample sizes</li>
<li>Provides copies of any criteria utilized in a review with the report in a timely manner</li>
<li>Returns cases on or before the due date and time</li>
<li>Makes telephone calls as mandated by the state and/or client specifics</li>
<li>Maintains proper credentialing and state licenses and any special certifications or requirements necessary to perform the job</li>
<li>Performs other duties as assigned including identifying and responding to quality assurance issues, complaints, regulatory issues, depositions, court appearances, or audits</li>
<li>Board certification required, active practice required</li>
</ul></li></ul><p></p><p>
PLEASE BE AWARE: In the interest of the security of all parties, Dane Street will never conduct interviews via text or request checks from candidates for any reason including the purchase of equipment.</p><p></p><p><b>
Benefits</b></p><p><b>
Benefits</b></p><p></p><ul>
<li>Robust opportunity for supplemental income</li>
<li>Schedule flexibility and predictable work hours - You choose services and case types, dictate volume, and conduct exams and reviews based on your schedule availability</li>
<li>No doctor/patient relationship is established and no treatment is provided. These are advisory-only opinions.</li>
<li>Enhanced industry expertise strengthening your medical practice with medical necessity and utilization review/management expertise</li>
<li>Expanded credentials as an expert in Independent Medical Exams and physician advisor services</li>
<li>Fully prepped cases, streamlined case flow, transcription services at no cost, and user-friendly work portal</li></ul></div>

Board Certified-(M.D, D.O) South Carolina Diagnostic Radiology Advisor

<div><p>As Physician Reviewer/Advisor for Independent Medical Exams (IME), you will utilize clinical expertise and reviews insurance appeals, and prospective and retrospective claims. The Physician Reviewer will provide an interpretation of the medical necessity of services provided by other healthcare professionals in compliance with client specific policies, nationally recognized evidence-based guidelines, and standards of care.</p><p></p><p><b>
MAJOR DUTIES AND RESPONSIBILITIES:</b></p><ul><li><ul>
<li>Reviews all medical records and addresses each question posed by the client utilizing client specific criteria or other nationally recognized evidence-based criteria</li>
<li>Ensures that the rationale for the determination is clear, concise, and contains adequate supporting documentation to substantiate the decision</li>
<li>Identifies, critiques, and utilizes current criteria and resources such as national, state, and professional association guidelines and peer-reviewed literature that support sound and objective decision-making and rationales in reviews; refrains from using case studies, cohorts, and the like to make decisions due to their limited sample sizes</li>
<li>Provides copies of any criteria utilized in a review with the report in a timely manner</li>
<li>Returns cases on or before the due date and time</li>
<li>Makes telephone calls as mandated by the state and/or client specifics</li>
<li>Maintains proper credentialing and state licenses and any special certifications or requirements necessary to perform the job</li>
<li>Attends all required orientation and training</li>
<li>Performs other duties as assigned including identifying and responding to quality assurance issues, complaints, regulatory issues, depositions, court appearances, or audits</li>
<li>Board certification required, active practice required</li>
</ul></li></ul><p></p><p>PLEASE BE AWARE: In the interest of the security of all parties, Dane Street will never conduct interviews via text or request checks from candidates for any reason including the purchase of equipment.</p><p></p><p><b>
Benefits</b></p><p><b>
Benefits</b></p><p></p><ul>
<li>Robust opportunity for supplemental income</li>
<li>Schedule flexibility and predictable work hours - You choose services and case types, dictate volume, and conduct exams and reviews based on your schedule availability</li>
<li>No doctor/patient relationship is established and no treatment is provided. These are advisory-only opinions.</li>
<li>Enhanced industry expertise strengthening your medical practice with medical necessity and utilization review/management expertise</li>
<li>Expanded credentials as an expert in Independent Medical Exams and physician advisor services</li>
<li>Fully prepped cases, streamlined case flow, transcription services at no cost, and user-friendly work portal</li></ul></div>

Board Certified-(M.D, D.O) Yakima Internal Medicine Advisor, Certified for IME

eviCore healthcare

Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States.<br>Reviews appeals for denied services related to current relevant medical experience or knowledge in accordance with appeal policies, if so delegated.<br>Provides timely peer-to-peer discussions with referring physicians to clarify clinical information and to explain review outcome decisions.<br>Maintains necessary credentials and immediately informs eviCore of any adverse actions relating to medical licenses and/or board certifications.<br>Participates in strategic planning for and evaluation of the Care Management<br><br>The successful candidate will be an M.D. or D.O. with a current, active, U.S. state medical license and board certified in Gastroenterology, recognized by the American Board of Medical Specialties (ABMS), with recent practice experience in direct patient care (within the past 18 months).<br>Must have a minimum of 5 years clinical experience, beyond residency/fellowship <br>Knowledge of applicable state and federal laws, URAC and NCQA standards a plus, and familiarity with automated processes and computer applications and systems is required<br><br>No nights, no weekends, not call.<br>Predictable work schedule<br>Full and part time opportunities<br>Salaried position with benefits<br>Supportive organization with collaborative culture<br><br>eviCore healthcare is committed to making a positive impact on healthcare, and also making a positive impact on our employees. eviCore offers a variety of perks and benefits including, but not limited to:<br>Flexible scheduling and work/life balance with remote and work from home opportunities<br>4 weeks of PTO(starting) per year plus paid holidays<br>One week of CME<br>Education assistance, tuition reimbursement and professional certifications <br>Health, dental, vision, and life benefits with employer funded HSA<br>Paid Volunteer Community Service Days <br>Ample opportunities for growth, advancement, and promotion <br>401k retirement plan with company match of 50% employee contributions up to 6% <br><br>eviCore is committed to hiring and retaining a diverse workforce. We are an Equal Opportunity Employer, making decisions without regard to race, color, religion, sex, national origin, age, veteran status, disability, or any other protected class. Applicants must be able to pass a drug test and background investigation

Physician / Gastroenterology / Texas / Permanent / Associate Medical Director - Gastro - 100% Remote Job Job

Physician / Gastroenterology / California / Permanent / Associate Medical Director - Gastro - 100% Remote Job Job

Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States.<br>Reviews appeals for denied services related to current relevant medical experience or knowledge in accordance with appeal policies, if so delegated.<br>Provides timely peer-to-peer discussions with referring physicians to clarify clinical information and to explain review outcome decisions.<br>Maintains necessary credentials and immediately informs eviCore of any adverse actions relating to medical licenses and/or board certifications.<br>Participates in strategic planning for and evaluation of the Care Management<br><br>The successful candidate will be an M.D. or D.O. with a current, active, U.S. state medical license and board certified in Cardiology, recognized by the American Board of Medical Specialties (ABMS), with recent practice experience in direct patient care (within the past 18 months).<br>Must have a minimum of 5 years clinical experience, beyond residency/fellowship <br>Knowledge of applicable state and federal laws, URAC and NCQA standards a plus, and familiarity with automated processes and computer applications and systems is required<br><br>No nights, no weekends, not call.<br>Predictable work schedule<br>Full and part time opportunities<br>Salaried position with benefits<br>Supportive organization with collaborative culture<br><br>eviCore healthcare is committed to making a positive impact on healthcare, and also making a positive impact on our employees. eviCore offers a variety of perks and benefits including, but not limited to:<br>Flexible scheduling and work/life balance with remote and work from home opportunities<br>4 weeks of PTO(starting) per year plus paid holidays<br>One week of CME<br>Education assistance, tuition reimbursement and professional certifications <br>Health, dental, vision, and life benefits with employer funded HSA<br>Paid Volunteer Community Service Days <br>Ample opportunities for growth, advancement, and promotion <br>401k retirement plan with company match of 50% employee contributions up to 6% <br><br>eviCore is committed to hiring and retaining a diverse workforce. We are an Equal Opportunity Employer, making decisions without regard to race, color, religion, sex, national origin, age, veteran status, disability, or any other protected class. Applicants must be able to pass a drug test and background investigation

Physician / Cardiology / Texas / Permanent / Associate Medical Director - Cardiology - 100% Remote Job Job

Search 10000+ Utilization review physician jobs near you this November. New roles added regularly across leading industries. Apply today.

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Physician Advisor - MedStar Washington Hospital Center

Board Certified-(M.D, D.O) South Carolina Diagnostic Radiology Advisor

Board Certified-(M.D, D.O) Yakima Internal Medicine Advisor, Certified for IME

Physician / Gastroenterology / Texas / Permanent / Associate Medical Director - Gastro - 100% Remote Job Job

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