Medical Review Physician (Remote/Onsite) 2024-1376

Managed Care Advisors

397d • $190,000 - $200,000

About The Position

The Medical Review Physician at Managed Care Advisors is responsible for providing high-quality professional guidance and conducting case reviews on complex medical cases. This role involves collaborating with various stakeholders to optimize healthcare benefits administration, ensuring timely and accurate medical determinations, and supporting the Medical Services Teams under the supervision of the Medical Director. The position requires a detail-oriented individual who can assess environmental exposures and complex health conditions to facilitate optimal access to necessary services.

Requirements

• Medical degree (MD or DO)
• Unrestricted and current license to practice medicine in one US State
• Minimum of 10 years of relevant clinical experience
• Minimum of 5 years of experience with occupational medicine or health care programs
• Minimum of 2 years clinical experience with a Federal Health Care Program
• Excellent oral and written communication skills
• Strong investigation and organizational skills
• Demonstrated ability to influence without authority
• Ability to work in a team environment
• Proficiency in Microsoft Office
• United States Citizenship
• Ability to obtain and maintain confidential-level security clearance(s)

Nice To Haves

• Experience in developing training materials
• Familiarity with quality improvement activities
• Experience in research and analysis related to health outcomes

Responsibilities

• Conduct clinical assessments regarding program and benefit eligibility based on medical evidence.
• Determine if environmental exposure thresholds and latency periods have been met for claimed conditions.
• Perform physician reviews to support utilization activities and determine if program coverage criteria are met for requested healthcare services.
• Complete all reviews and render determinations within required timeframes.
• Adhere to SGS-MCA and client-specific protocols.
• Provide written clinical determinations to claimants and stakeholders as applicable.
• Collaborate with the clinical management team to develop or revise clinical protocols, policies, and procedures.
• Notify the supervisor of any quality concerns that arise.
• Provide clinical subject matter expertise to clinical teams and supporting business units as needed.
• Perform physician reviews on complex cases under case management to assist in developing case management plans.
• Provide clinical support to the case management and utilization review team for training and quality assurance activities.
• Develop and deliver personal quality improvement goals and participate in quality improvement initiatives.
• Participate in the SGS-MCA peer audit process and support client-directed audit processes.
• Identify and meet the training needs of the case management team and participate in training development and delivery.
• Attend internal and external client meetings as needed.

Benefits

• Medical insurance
• Dental insurance
• Vision insurance
• 401k and matching
• Paid time off (PTO)
• Disability insurance
• Life insurance
• Employee assistance program
• Flexible spending account or health savings account
• Additional voluntary benefits

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Industry: Professional, Scientific, and Technical Services
• Education Level: Ph.D. or professional degree
• Number of Employees: 10,001+ employees