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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 in New Jersey. 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 responsible for overseeing the administration of medical services within the company’s health plan, utilizing evidence-based medical policies and clinical guidelines to ensure that our members receive appropriate and cost-effective medical care. The role is pivotal in guiding the plan’s approach to care costs, clinical initiatives, and overall population health management and outcomes.
In this capacity, the physician will act as the clinical lead, collaborating closely with the state plan president and engaging 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.
