Utilization Management Medical Reviewer

Utilization Management Medical Reviewer

CareCentrix | Hartford, CT, 06112, US
Salary Range:$47,000 – $77,000 Salary range estimated by Zippia

Posted 13 days ago

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Description


Utilization Management Medical Reviewer

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Job ID: 2022-13901
Type: Part-Time Employee
# of Openings: 1
Category: Clinical / Utililization Management

Overview

As a part time Utilization Management Medical Reviewer you will conduct utilization review for medical necessity determinations. As appropriate and when required, this position interfaces with the internal staff, Providers, and ordering physicians.



Responsibilities

In this role, you will:

  • Consults with licensed and non-licensed reviewers on clinical issues related to authorization requests.
  • Conducts medical necessity review on cases that may not meet criteria, and issues adverse determinations as needed.
  • Accepts and conducts peer-to-peer consultations when requested by an ordering physician after an adverse determination has been issued, adhering to required timelines and regulations
  • Successfully completes and passes Inter-rater reliability testing and random case audits
  • Achieves Service Level Agreement (SLA) metrics and performance guarantees as required by health plan clients
  • Ability to work up to 15 hours a week (including weekends/holidays)
  • Other duties as appropriate


Qualifications

  • MD or DO with an active and unencumbered medical licenses ( in the states specific to the CareCentrix client payer account),
  • Appropriate current and unexpired specialty board certifications
  • 3-5 years experience in clinical practice
  • 3-5 years experience doing utilization review
  • Prior experience utilizing evidence-based clinical guidelines (e.g., Milliman/Interqual) is preferred.

Salary Range - $150 to $170 per hour

Hours - 15 to 20 hours per week to include 1 weekend day a month and 1 holiday cover a year

#IDCC

We are an equal opportunity employer. Employment selection and related decisions are made without regard to age, race, color, national origin, religion, sex, disability, sexual orientation, gender identification, or being a qualified disabled veteran or qualified veteran of the Vietnam era or any other category protected by Federal or State law.



Please see job description



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