Utilization Management Physician

Are you a Board Certified Medical Doctor (Family Medicine or Internal Medicine) looking for a full-time, remote job in a nonclinical setting?

Make sure to apply quickly in order to maximise your chances of being considered for an interview Read the complete job description below.

Then let me introduce you to ExamWorks

ExamWorks is seeking a physician board-certified in either Family Medicine, Internal Medicine to join the team full-time as a Utilization Management Physician Reviewer.

This position is 100% remote with a schedule of Monday through Friday 8:30am-5:00pm with weekend and holiday coverage (adjustments will be made to your Monday through Friday schedule that week.)

The Utilization Management Physician will be responsible for providing thorough and accurate reviews of utilization management cases to ensure the appropriate use of medical resources while continuing to hold high standards of patient care. The position will involve collaborating closely with the Medical Director, other team members, and clients to conduct reviews with a high level of accuracy and efficiency. This collaboration ensures that reviews are thorough, well documented, and align with established medical guidelines and standards.

Opportunity Highlights

• Work remotely
• Secure, easy-to-use online portal
• Paperless workflow requiring no medical record filing or storage

Responsibilities

• Perform utilization management reviews in an efficient and timely manner, ensuring each review is completed with careful attention to detail while maintaining high quality work.
• Review appeals or complaints that relate to medical review decisions by conducting a thorough assessment of all medical records, treatment plans, and other supporting documents from healthcare providers.
• Collaborate with the Medical Director and Senior Management to ensure effective coordination of the delivery of services to clients.
• Communicate with client Medical Directors and other stakeholders regarding the utilization management process; provide detailed explanation of review outcomes, address questions and concerns and ensure all parties are aware of any changes or updates in the process.
• Participate in the quality improvement of all steps in the review process.
• Act as a medical resource and provide guidance to Pharmacists and other team members regarding clinical questions.
• Communicate clearly and professionally with clients at regular meetings regarding quality and production.
• Audit cases and provide quality feedback as needed.
• Perform all other duties as assigned by management.

Requirements

• MD or DO degree
• Active board certification Family Medicine or Internal Medicine by ABMS or AOA
• One year minimum experience in Utilization Management or Peer Reviews in Commercial Payor
• Experience utilizing Interqual/MCG guidelines
• Active, unrestricted medical licensure in the United States
• 5+ years of clinical practice experience (including residency!)
• Ability to work within the United States

Qualification Expectations

• Ability to provide clinical guidance regarding the quality and/or clinical aspects of reviews and, when appropriate, directly communicates with reviewers, staff, and/or clients.
• Ability to interact with clients as needed, either independently or as a participating member of a group discussion between service and client, regarding the clinical quality aspects of the medical reviews.
• Must be able to review cases and data thoroughly to ensure that all necessary information meets quality standards.
• Must have strong knowledge of medical terminology and procedures, which may include utilization reviews, quality-assurance services compliance, and claims analysis.
• Must have knowledge of federal and/or state legislative mandates (ERISA and/or state law).
• Must be able to work well under pressure and or stressful conditions.
• Must possess the ability to manage change, delays, or unexpected events appropriately.
• Must be able to maintain confidentiality.
• Ability to follow all company policies and procedures in effect at time of hire and as they may change or be added from time to time.

About ExamWorks

We are a URAC accredited independent review organization with a robust network of physician reviewers across all specialties. Our company provides peer review services to a variety of clients including health plans, disability insurers, and workers' compensation insurers. xhyhwjd

Discover why ExamWorks is the largest credentialed expert medical panel in the industry today!