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Job Requirements of Physician Reviewer:
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Employment Type:
Contractor
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Location:
Nashville, TN (Onsite)
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Physician Reviewer
Careers Integrated Resources Inc
Nashville, TN (Onsite)
Contractor
Job Title : Physician Reviewer
Location: Nashville, TN
Duration: 12+ Months Contract (possibility of extension)
Job Description:
Location: Nashville, TN
Duration: 12+ Months Contract (possibility of extension)
Job Description:
- 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.
- Board Certified (ABMS) M.D. or D.O, unrestricted and active license to practice medicine requested and 5 years clinical experience to include inpatient experience, or any combination of education/experience that would provide an equivalent background.
- Must have understanding of managed care and demonstrate PC proficiency, as file review will be done via computer in most cases. (Note: Position does not provide direct patient care or medical diagnosis.)
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