Physician Reviewer

IEHP•California, MD

50d•Remote

About The Position

The Physician Reviewer provides support in clinical decision-making oversight and physician level guidance in quality management, utilization management, and care management. The Physician reviewer supports all IEHP departments in meeting the regulatory requirements set forth by the various government agencies. The Physician Reviewer shall perform Medical Review activities and provide IEHP Medical Director support. The Physician Reviewer shall perform determinations, communicate medical necessity reviews and support IEHP Medical Director(s) as needed or requested by IEHP. Commitment to Quality: The IEHP Team is committed to incorporate IEHP's Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Requirements

Five (5) years or more of post-residency experience in a recognized medical specialty required
Doctor of Medicine or Psy.D from an accredited institution required
Certification by one (1) of the American Specialty Boards required
Possession of an active, unrestricted, and unencumbered Physician's and Surgeon's Certificate issued by the State of California Medical Board or a Clinical Psychologist License issued by the California Board of Psychology required.
A physician certified in a state other than California may be employed prior to receipt of California certification provided that an application for a California physician and surgeon's certificate is filed in the state of California prior to date of appointment
Primary Care Physician in internal medicine, family practice or pediatrics preferred
Strong knowledge of: Medical and CMS regulations.
Administrative practices and procedures including but not limited to quality assessment and improvement, utilization review, peer review, credentialing and risk management.
Rules, regulations, policies, and standards related to managed care.
Principles of effective supervision and organization.
Methods, techniques, practices, principles, and literature in the broad field of medical sciences.
Overview of the highly specialized techniques, procedures, and equipment used in the medical or surgical specialties
Microcomputer applications such as Microsoft Office, Word, Excel, and Access helpful.
Strong communication skills
Ability to create and maintain positive working relationships
While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; talk or hear; and taste or smell
The employee must occasionally lift or move up to 25 pounds
Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus

Nice To Haves

Medical Director for an IPA, medical group, or HMO highly desirable
Utilization management experience is a plus
Primary Care Physician in internal medicine, family practice, or pediatrics preferred
At least one (1) year of medical leadership experience preferred