Clinical Service Request Evaluator

4 weeks ago


New York, New York, United States w3r Consulting Full time
Job Summary:

Evaluates clinical service requests made by an organization's members and providers. Uses clinical judgment in conjunction with organization's Utilization Management criteria to adjudicate these requests. Performs peer to peer discussions. Actively participates in all unit continuous quality improvement activities. Other duties as assigned by the Medical Director. 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.

Key Responsibilities:
  • Evaluates clinical service requests
  • Uses clinical judgment to adjudicate requests
  • Performs peer to peer discussions
  • Participates in continuous quality improvement activities


Requirements:
  • Board Certified (ABMS) M.D. or D.O
  • Unrestricted and active license to practice medicine
  • 5 years clinical experience

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