Utilization Management Physician Reviewer - Remote

Overview

Dane Street, a certified “Great Place to Work” company is seeking a Physician to provide utilization review services for the Group Health Department.

In Short

• Review requests for Prior Authorizations and Appeals including medical records.
• Ensure clear, concise, and well-supported rationales for determinations.
• Make mandated phone calls.
• Provide responses in member friendly language using provided templates.
• Return cases on or before the due date and time.
• Assist with quality assurance of reports prior to submission to clients.
• Maintain proper credentialing, state licenses, and any special certifications.
• Utilize current criteria and resources for decision-making.
• Identify and respond to quality assurance issues and audits.
• Other duties & special projects, as assigned.

Requirements

• Board Certified M.D. or D.O. with current, unrestricted clinical license in any state in the US.
• Minimum five years of postgraduate experience.
• Extensive clinical business background required.
• Experience in Utilization Management with criteria review.
• Medicaid/Medicare experience preferred.

Benefits

• Opportunity to work in a certified “Great Place to Work” environment.
• Engagement in meaningful work that impacts patient care.
• Supportive team culture.
• Flexible work arrangements.
• Professional development opportunities.