Job detail

Medical Peer Reviewer

HealthFirst

#Medical Records #Compliance Training #Medicare #Medicaid #Authorization #Clinical Judgment #Regulations #Emergency Medicine #Board Certified

Quick overview

The Medical Peer Reviewer consults on medical necessity within utilization management, ensuring adherence to internal and external regulations by assessing authorization requests and claims payments based on medical records. This role involves rendering determinations within regulatory timeframes, maintaining productivity standards, and collaborating across various medical and management departments.

Requirements summary

Minimum Qualifications

require being a licensed M.D., D.O., D.M.D., or D.D.S., and being Board Certified in a specialty recognized by the American Board of Medical Specialties. Preferred qualifications include board certification in specific fields like Internal Medicine or Family Practice, and relevant experience in utilization management and knowledge of Medicare/Medicaid plans.

professional certificateCase ManagementCommunicationTime ManagementProblem-SolvingCritical ThinkingProductivity ManagementMedical NecessityClinical JudgmentRegulatory AdherenceUtilization ManagementCompliance TrainingAuthorization ReviewInter-Rater Reliability TestingClaims Payment Review

Job description

We are an equal opportunity employer.
HF Management Services, LLC complies with all applicable laws and regulations.
Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis.
HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified.
If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 .
In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying.
Only reasonable accommodation requests related to applying for a position within HF Management Services, LLC will be reviewed at the e-mail address and phone number supplied.
Thank you for considering a career with HF Management Services, LLC.
Know Your Rights All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company.
Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about.
If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst.
Healthfirst will never ask you for money during the recruitment or onboarding process.
Healthfirst is New York’s largest not-for-profit health insurer offering it’s nearly 1.7 million members access to high-quality, affordable healthcare.
As part of the community for nearly 30 years, Healthfirst’s unique advantage is rooted in its belief that good health doesn’t start in a doctor’s office.

Medical Peer Reviewer

Quick overview

Requirements summary

Minimum Qualifications

Job description

Benefits

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