Primary Care Physician Specialist
3 weeks ago
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.
- Submit information to the Department using formats specified by each individual Bureau.
- Assist in the development of in-house training programs, medically necessary criteria, and quality of care indicators.
- Help the Department in determining if any changes should be made to criteria or regulations to better serve Medical Assistance recipients.
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.
Benefits
- Competitive pay rate of $130 per hour.
- Opportunity to work with a dynamic team at Staff Today Inc.
- Professional development opportunities.
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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