MAKE Corporation
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19027 - Physician Reviewer
Chicago, IL 60601 US
Posted: 02/20/2023
2023-02-20
2023-04-22
Industry: HCSC Other
Job Number: 39534
Job Description
Physician Reviewer
AF – 19027
Location: Remote in IL, TX, OK, MT, or NM
Tenure: 26-month contract
Responsibilities:
Note: Position does not provide direct patient care or medical diagnosis.
Qualifications:
AF – 19027
Location: Remote in IL, TX, OK, MT, or NM
Tenure: 26-month contract
Responsibilities:
- Evaluates clinical service requests made by an organization's members and providers.
- Uses clinical judgment in conjunction with organization's criteria to adjudicate these requests.
- May also provide clinical leadership in other areas of the organization.
- Identifies opportunities to manage members' clinical situations with a view toward creative problem solving and anticipation of possible future clinical problems for the member.
- Participates in the process to evaluate clinical service requests.
- Practices anticipatory case management for members whose cases come for review, in partnership with case managers.
- Participates in the Physician Review Units' appeal process of service denials.
- Participates in the development of Physician Review Units' policies and procedures.
- Actively participates in all unit continuous quality improvement activities.
- Other duties as assigned by the Medical Director.
Note: Position does not provide direct patient care or medical diagnosis.
Qualifications:
- Board Certified (ABMS) M.D. or D.O, unrestricted and active license to practice medicine requested
- Minimum 5 years clinical experience to include inpatient experience, or any combination of education/experience that would provide an equivalent background.
- Must understand managed care and demonstrate PC proficiency, as file review will be done via computer in most cases.
Job Requirements
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