About the job
Full Time Direct Hire Opportunity
*Must have a Board Certification as an MD or DO and be Licensed in Florida or NC or have an active IMLCC license/be eligible to apply for the IMLCC
Hours: 8am - 5pm in your local time zone
Call rotation - 1 weekend every 16 weeks
6+ years of clinical practice experience and at least one year of utilization review experience at a managed care plan
- Provide timely medical reviews that meet quality parameters.
- Provide clinical determinations based on evidence-based criteria and guidelines and policies, while utilizing clinical acumen.
- Clearly and accurately document all communication and decision-making in workflow tools, ensuring a member could easily reference and understand your decision
- Use correct templates for documenting decisions during case review.
- Meet the appropriate turn-around times for clinical reviews.
- Receive and review escalated reviews.
- Conduct timely peer-to-peer discussions
- Compliance with all applicable laws and regulations