Utilization Management Physician Reviewer

Job Summary

A company is looking for a Utilization Management Physician Reviewer.

Key Responsibilities

• Review service requests and document decision rationales according to policies and industry standards
• Utilize evidence-based criteria and clinical reasoning for making UM determinations
• Collaborate with care teams to enhance patient care delivery and maintain compliance with regulations

Required Qualifications

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