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Utilization Management Physician Lead
3 months ago
Job Profile:
- Trains and educates on medical review activities pertaining to utilization review, claims review, quality assurance, and medical review of complex, controversial, or experimental medical services.
Minimum Requirements
- Five years in a professional setting such as hospital, clinic, or home health environment.
- Effective communication and interpersonal skills.
- Demonstrated knowledge of CMS guidelines, health plan criteria, MCG criteria, and state, local, or federal guidelines relating to utilization management.
- Demonstrated knowledge of case management, utilization management, quality management, discharge planning, and other cost management programs.
- Possess a strong progressive and customer-focused approach to building and maintaining customer and provider relations.
- Must have or be eligible to have a current and unrestricted Nevada medical license.
- Minimum of 5 years work experience related to inpatient management, case management, utilization management, quality management, discharge planning, or other cost management.
- Board Certified in Internal Medicine, Family Practice, or other primary care specialty.
- Current Nevada DEA certificate required prior to start date.
- Current Nevada Pharmacy license required prior to start date.
- BLS/ACLS certification prior to start date.
Preferred Qualifications
- Additional management degree such as MBA, MPH a plus.
