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at Gee-Gee DFW Jobs in Washington

Our client is a leader in utilization management and are using evidence-based approach to leverage their exceptional capabilities, powerful analytics, and acute sensitivity to the challenges and needs of everyone involved across the healthcare continuum. By applying proven talent and leading-edge technology, they harness healthcares evolving demand and inherent change to realize healthcare innovation and deliver improved results and a positive experience for everyone.
We are hiring several physicians for medical management positions who can
Provide timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States.
Review appeals for denied services related to current relevant medical experience or knowledge in accordance with appeal policies, if so delegated.
Provide timely peer-to-peer discussions with referring physicians to clarify clinical information and to explain review outcome decisions.
Document all actions related to clinical review sessions and attests to appeal review qualifications as required.
Maintains files of all reviews as required by law and Health Plans to retrieve data.
Maintains necessary credentials and immediately informs the organization of any adverse actions relating to medical licenses and/or board certifications.
Supports the annual review of utilization review criteria.
Participates in strategic planning for and evaluation of the Care Management process/unit.
Assists with staff educational training and in-service programs and serves as a clinical resource for the staff.

The ideal candidate will have
an M.D. or D.O. with a current, active, U.S. state medical license and board certified in a specialty recognized by the American Board of Medical Specialties (ABMS)
minimum 5 years experience in Oncology
board certification in medical oncology or hematology or radiation oncology
Must have recent practice experience in direct patient care (within the past 18 months).
Knowledge of applicable state and federal laws, URAC and NCQA standards a plus, and familiarity with automated processes and computer applications and systems is required.
This position offers a competitive base salary, short term incentive cash bonus and exceptional benefits including a 401k plan with up to 6% contribution.

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Published at 02-12-2019
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