State Licensed Utilization Management Physician Reviewer

Job Summary

A company is looking for a Utilization Management Physician Reviewer.

Key Responsibilities

• Review service requests and document decision rationale according to policies and standards
• Utilize evidence-based criteria and clinical judgment to make utilization management determinations
• Collaborate with care teams to enhance efficient and effective patient care delivery

Required Qualifications

• At least one year of experience in Utilization Management for Medicare and/or Medicaid
• A current, unrestricted clinical license to practice medicine in the U.S
• Graduate of an accredited medical school with an M.D. or D.O. degree
• 3-5 years of clinical practice in a primary care setting
• Understanding of managed care and relevant healthcare practices