Medical Director- Physician Reviewer
11 days ago
El Paso
Job Title : Physician Reviewer Duration : 9-10 Months Assignment (Temp to hire) Locations : Fully Remote- (WFH) Schedule : Monday to Friday – First Shift NOTE: Must reside in Texas. Must have Texas Medical Licensure. Job Profile Summary • Evaluates clinical service requests made by an organization's members and providers., • Uses clinical judgment in conjunction with organization's criteria to adjudicate these requests., • May also provide clinical leadership in other areas of the organization., • Identifies opportunities to manage members' clinical situations with a view toward creative problem solving and anticipation of possible future clinical problems for the member. Participates in the process to evaluate clinical service requests., • Practices anticipatory case management for members whose cases come for review, in partnership with case managers., • Participates in the Physician Review Units' appeal process of service denials., • Participates in the development of Physician Review Units' policies and procedures., • Actively participates in all unit continuous quality improvement activities., • Other duties as assigned by the Medical Director. Board Certified (ABMS) M.D. or D.O, unrestricted and active license to practice medicine requested and 5 years clinical experience to include inpatient experience, or any combination of education/experience that would provide an equivalent background., • Must have understanding of managed care and demonstrate PC proficiency, as file review will be done via computer in most cases., • (Note: Position does not provide direct patient care or medical diagnosis.) EEO: “Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of – Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.”