Primary Care Physician Specialist

4 days ago


Harrisburg, Pennsylvania, United States Staff Today Inc Full time
Job Title: Primary Care Physician Specialist

Job Summary:

We are seeking a highly skilled Primary Care Physician Specialist to join our team at Staff Today Inc. As a Primary Care Physician Specialist, you will be responsible for conducting utilization and quality reviews of services for our Department.

Key Responsibilities:

* Conduct prospective, concurrent, and retrospective review of assigned adult and pediatric inpatient and outpatient medical cases covered by the Department
* Make determinations regarding medical necessity, place of service, appropriateness, compensability, and/or quality of care of services prescribed for and provided to Medicaid recipients
* Compile case findings, prepare summaries of case findings, make recommendations for case disposition, identify program violations, prepare appealed cases for hearings, and/or be available to testify at administrative hearings for cases under appeal
* Assist in the development of in-house training programs, medically necessary criteria, and quality of care indicators

Requirements:

* Be board certified in family practice medicine
* Possess an active Pennsylvania medical license
* Demonstrate an understanding of utilization review processes
* Basic computer skills to include, but not limited to, Microsoft Office Products

What We Offer:

* Competitive pay rate
* Opportunities for professional growth and development

How to Apply:

If you are a motivated and detail-oriented Primary Care Physician Specialist looking for a new challenge, please submit your application to Staff Today Inc.

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