Medical Director – Pediatric Otolaryngology – Evicore - Remote
Remote
Core
Deliver evidence-based medical reviews and conduct peer-to-peer physician consultations to determine medical necessity for pediatric otolaryngology cases.
Role type
Senior clinical reviewer (Pediatric Otolaryngology)
Builds
Evidence-based medical decisions for patient care
Domain
Healthcare / Utilization Review
Required skills
Clinical judgment, Evidence-based decision making, Physician consultation, Medical necessity assessment, Regulatory knowledge, Case management
Preferred skills
Knowledge of URAC and NCQA standards
Technologies
Case management software
Responsibilities
Review specialized evidence-based medical cases for medical necessity, Conduct peer-to-peer calls with referring providers, Recommend alternative services or treatments, Collaborate with physician colleagues on evidence-based decision making
Seniority
Senior, hands-on IC