State Licensed Utilization Management Physician Reviewer

A company is looking for a Utilization Management Physician Reviewer. Key Responsibilities Review service requests and document rationale for decisions in accordance with policies and industry standards Utilize evidence-based criteria and clinical reasoning to make utilization management determinations Collaborate with care teams to ensure efficient and effective patient care delivery Required Qualifications At least one year of experience in Utilization Management for Medicare and/or Medicaid A current, clinical, unrestricted license to practice medicine in the United States Graduate of an accredited medical school with an M.D. or D.O. degree 3-5 years of clinical practice in a primary care setting Deep understanding of managed care and related processes

Apr 28, 2025 - 07:43

A company is looking for a Utilization Management Physician Reviewer. Key Responsibilities Review service requests and document rationale for decisions in accordance with policies and industry standards Utilize evidence-based criteria and clinical reasoning to make utilization management determinations Collaborate with care teams to ensure efficient and effective patient care delivery Required Qualifications At least one year of experience in Utilization Management for Medicare and/or Medicaid A current, clinical, unrestricted license to practice medicine in the United States Graduate of an accredited medical school with an M.D. or D.O. degree 3-5 years of clinical practice in a primary care setting Deep understanding of managed care and related processes