Licensed Physician Reviewer
Core
Primary physician reviewer for Utilization Management (UM) cases, covering specified territories, attending health plan calls, and coordinating patient care.
Role type
Licensed Physician Reviewer (Utilization Management)
Builds
Delegated Utilization Management processes and patient care coordination
Domain
Healthcare / Utilization Management
Deliverable
client delivery
Required skills
Analytical and deductive reasoning, Medical judgment, Problem-solving, Organizational skills, Written and verbal fluency in English, Microsoft Office proficiency
Preferred skills
Hospital medicine experience, Utilization review experience
Technologies
Microsoft Office (Outlook, Excel, Word, PowerPoint)
Responsibilities
Cover specified territories for Delegated UM, Establish 2-3 cases daily per market, Ensure attendance on health plan and local calls, Participate in weekly PCP and SNF meetings, Advise other physician reviewers
Seniority
Mid-Senior, hands-on IC