Sleep Medicine Medical Reviewer
Job Summary
A company is looking for a Sleep Medicine - Utilization Management Medical Reviewer (Part Time).
Key Responsibilities
- Conduct medical necessity reviews and issue adverse determinations as needed
- Achieve Service Level Agreement (SLA) metrics and performance guarantees for health plan clients
- Work up to 20 hours a week, including weekends and holidays
Required Qualifications, Training, and Education
- MD or DO with an active and unencumbered medical license
- Current and unexpired specialty board certifications in internal medicine with certification in sleep medicine, pulmonology, or as a somnologist
- 3-5 years of experience in clinical practice
- 3-5 years of experience in utilization review
- Prior experience utilizing evidence-based clinical guidelines (e.g., Milliman/Interqual) is preferred
COMPLETE JOB DESCRIPTION
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Company Overview
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