Utilization Management Physician Reviewer

ExamWorks UM Strategies is seeking a board-certified physician to join the team as a Utilization Management Physician. 

This position is 100% remote with a schedule of Monday through Friday 8:30am-5:00pm EST, with flexibility.  You must be able to work one weekend a month (adjustments will be made to your Monday through Friday schedule that week.)

The Utilization Management Physician will be responsible for providing thorough and accurate reviews of utilization management cases to ensure the appropriate use of medical resources while continuing to hold high standards of patient care. The position will involve collaborating closely with both the Medical Director, other team members, and clients to conduct reviews with a high level of accuracy and efficiency. This collaboration ensures that reviews are thorough, well documented, and align with established medical guidelines and standards.

Responsibilities

• Perform utilization management reviews in an efficient and timely manner, ensuring each review is completed with careful attention to detail while maintaining high quality work.
• Review appeals or complaints that relate to medical review decisions by conducting a thorough assessment of all medical records, treatment plans, and other supporting documents from healthcare providers.
• Collaborate with the Medical Director and Senior Management to ensure effective coordination of the delivery of services to clients.
• Communicate with client Medical Directors and other stakeholders regarding the utilization management process; provide detailed explanation of review outcomes, address questions and concerns and ensure all parties are aware of any changes or updates in the process.
• Participate in the quality improvement of all steps in the review process.
• Act as a medical resource and provide guidance to Pharmacists and other team members regarding clinical questions.
• Communicate clearly and professionally with clients at regular meetings regarding quality and production.
• Audit cases and provide quality feedback as needed.
• Perform all other duties as assigned by management.

• MD, DO, or DPM degree required. Current, active unrestricted license to practice medicine required
• 5+ years of experience in medical practice required (this can include residency)
• Must have a Board Certification in an ABMS or AOA-recognized specialty required if an MD or DO. Current active, unrestricted license to practice medicine required.
• Ability to provide clinical guidance regarding the quality and/or clinical aspects of reviews and, when appropriate, directly communicates with reviewers, staff, and/or clients.
• Ability to interact with clients as needed, either independently or as a participating member of a group discussion between service and client, regarding the clinical quality aspects of the medical reviews.
• Must be able to review cases and data thoroughly to ensure that all necessary information meets quality standards.
• Must have strong knowledge of medical terminology and procedures, which may include utilization reviews, quality-assurance services compliance, and claims analysis.
• Must have knowledge of federal and/or state legislative mandates (ERISA and/or state law).
• Must be able to work well under pressure and or stressful conditions.
• Must possess the ability to manage change, delays, or unexpected events appropriately.
• Must be able to maintain confidentiality.
• Ability to follow all company policies and procedures in effect at time of hire and as they may change or be added from time to time.

WHO WE ARE

Founded in 1995, AllMed provides clinical decision making and utilization management solutions to leading paer and provider organizations. We work closely with your team toward a shared vision of healthcare that delivers the highest quality, values, patient experience, and ensures both appropriate care and utilization of health-related services. Out solutions are developed and delivered by experts - they are thoughtfully designed to integrate seamlessly into your organization and help you deliver the right care to the right patients at the right time.

Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy, genetic information, disability, status as a protected veteran, or any other protected category under applicable federal, state, and local laws.

Equal Opportunity Employer - Minorities/Females/Disabled/Veterans

AllMed offers a fast-paced team atmosphere with competitive benefits (medical, vision, dental), paid time off, and 401k.