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Clinical Utilization Review Specialist
2 months ago
Vivo HealthStaff is seeking a Utilization Review Physician for a prominent Managed Care Insurance Plan. This role necessitates a commitment of 4 days per month on-site.
The Utilization Review Physician serves as the primary clinical authority for the health plan. This position is accountable for overseeing the provision of medical services within the company’s health plan, employing evidence-based medical policies and clinical guidelines to guarantee that our members receive appropriate and cost-effective medical care. The role plays a crucial part in steering the plan's direction concerning care costs, clinical initiatives, and the management of population health outcomes.
As the clinical lead, you will collaborate closely with the state plan president and engage with state regulators, healthcare providers, and market facilities.
Key Qualifications:
- Board Certification in a specialty recognized by either the American Board of Medical Specialties or the American Osteopathic Association.
- Unrestricted Medical License in New Jersey.
- A minimum of 10 years of clinical experience following residency.
