Physician Reviewer

4 weeks ago


Chicago, Illinois, United States Mitchell Martin Inc Full time
Our client, a member owned health insurance company, is seeking a Physician Reviewer



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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