The Physician Reviewer manages Utilization Management cases and coordinates care for patients across assigned territories. Responsibilities include advising other reviewers, attending health plan calls, and participating in process and quality improvement initiatives.
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The Physician Reviewer is the primary physician reviewer for Utilization Management (UM) cases in our organization.
Other duties include advising other physician reviewers and attending daily calls with health plan teams and our local teams assisting with this function and coordinating care for our patients.
The position will also participate in Process and Quality improvement in our developing area of Delegated Utilization Management.
ESSENTIAL JOB DUTIES/RESPONSIBILITIES: Provides Delegated UM by covering the specified territories as assigned: Establish 2-3 cases a day for each market covered (up to 6 markets); ensures attendance on all health plan and local calls; calls in for the weekly Primary Care Provider (PCP) and Skilled Nursing Facility (SNF) meetings covering the assigned territories.
Advises other physician reviewers.
Other duties as assigned and modified by manager.
Excellent analytical and deductive reasoning skills Good judgement and problem-solving skills Professional and effective communication skills Strong organizational skills Written and verbal fluency in English Proficient in the use of Microsoft Office products such as Outlook, Excel, Word and PowerPoint EDUCATION AND EXPERIENCE CRITERIA: Graduate from accredited Medical School with a valid, unrestricted license is required Completion of Internal Medicine or Family Practice residency Board Certification in - Pulmonology Two (2) years’ experience in Hospital medicine preferred At least one (1) year of utilization review experience preferred PAY RANGE: $204,761 - $292,515 Salary The posted pay range represents the base hourly rate or base annual full-time salary for this position. Final compensation will depend on a variety of factors including but not limited to experience, education, geographic location, and other relevant factors. This position may also be eligible for a bonuses or commissions. EMPLOYEE BENEFITS https://chenmed.makeityoursource.com/helpful-documents We’re ChenMed and we’re transforming healthcare for seniors and changing America’s healthcare for the better. Family-owned and physician-led, our unique approach allows us to improve the health and well-being of the populations we serve. We’re growing rapidly as we seek to rescue more and more seniors from inadequate health care. ChenMed is changing lives for the people we serve and the people we hire. With great compensation, comprehensive benefits, career development and advancement opportunities and so much more, our employees enjoy great work-life balance and opportunities to grow. Join our team who make a difference in people’s lives every single day. Current employees, if you want to apply to our internal career site, please click HERE Current Contingent Worker please see job aid HERE to apply #LI-Remote
Requires a medical school degree, a valid unrestricted license, and board certification in Pulmonology with a residency in Internal Medicine or Family Practice. Preference is given to candidates with two years of hospital medicine and one year of utilization review experience.
