Licensed Physician Reviewer - Nephrologist

ChenMed

11d•$204,761 - $292,515•Remote

About The Position

The Physician Reviewer is the primary physician reviewer for Utilization Management (UM) cases. The role also advises other physician reviewers, attends daily calls with health plan and local teams, and coordinates care for patients. The position participates in process and quality improvement in the developing area of Delegated Utilization Management. The role provides delegated UM coverage for assigned territories and may perform other duties as assigned and modified by the manager.

Requirements

Graduate from an accredited medical school and hold a valid, unrestricted license.
Complete an Internal Medicine or Family Practice residency.
Hold board certification in the residency area.
Demonstrate excellent analytical and deductive reasoning skills.
Demonstrate good judgment and problem-solving skills.
Have professional and effective communication skills.
Have strong organizational skills.
Be fluent in written and spoken English.
Be proficient with Microsoft Office products, including Outlook, Excel, Word, and PowerPoint.

Nice To Haves

Two years of experience in hospital medicine.
At least one year of utilization review experience.

Responsibilities

Provide delegated Utilization Management coverage for assigned territories.
Establish 2–3 cases a day for each market covered, up to six markets.
Attend all health plan and local calls.
Attend weekly Primary Care Provider and Skilled Nursing Facility meetings for assigned territories.
Advise other physician reviewers.
Participate in process and quality improvement for Delegated Utilization Management.
Coordinate care for patients.
Perform other duties as assigned and modified by the manager.