Physician Reviewer
4 weeks ago
Location: Chicago, IL
Position Type: Contract
Job Responsibilities and Requirements:
- Time Commitment: This position requires a 2-month, full-time (40 hr./week | M-F) commitment to undergo and complete training. After this training, there will be a transition to at least 2 weekends per month and 2 holidays per year.
- 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.
- Participates in provider collaboration telephonically.
- Actively participates in all unit continuous quality improvement activities.
- Other duties as assigned by the hiring manager.
- 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 computer proficiency (Microsoft Office), adaptability to multiple computer software platforms, as file review will be done via computer.
- Position requires sedentary work of at least 8 hours/day, in most cases.
- Position requires secure and private environment to perform all medical director duties, including during training, and must be mindful of HIPAA and privacy guidelines.
- The position is administrative and does not provide direct patient care or medical diagnosis.
- Required: Board certified with unrestricted medical license in one of the 50 US states.
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