Are you a BC MD or DO BC by an Approved ABMS Board preferably in a primary care specialty (Internal Medicine, OB, Med/Peds, Family Practice Pediatrics or Emergency Medicine) or other specialty (and familiar with Medicare patients) who is ready for a change? This is a 32 hour a week position with the expectation you will be involved in some clinical activity.
This is and outstanding opportunity for someone who is interested in working a Utilization Review role in the Columbus, OH region. It is required you have a Pennsylvania license that is in good standing. It is a plus if you have Medical Director experience or even experience working with a health plan company.
This opportunity comes with a 20% performance bonus structure and there is the potential to earn more. Client is willing to offer nationwide relocation.
This is an opportunity that will allow you to use all your years of clinical knowledge giving back in which you would be working for a health plan advising on the best care for patients through case reviews and peer to peer reviews.
In this role you will :
- report to the VP of Medical Affairs
- 4 days a week working as a Medical Director with one day a week in clinical practice either in your own practice or working in an under served community
- In addition to doing utilization management activities, but also medical review activities pertaining to utilization review, quality assurance, medical review of complex, and controversial or experimental medical services such as transplants utilizing the services of consultants
- Operate in accordance with regulatory, state, corporate, and accreditation requirements.
- Identify unusual provider practice patterns, and adequacy of benefit/payment components
- Assist in reducing unwarranted variation in clinical practice in order to improve the quality and cost of care.
- Reviews claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment
To be considered for this role, you must still be in direct patient care practice.
Our client offers a robust benefits package which includes:
• Competitive pay • Health, Vision and Dental Benefits • Life Insurance • Tuition Reimbursement • 401 (k) Retirement Program • Employee Stock Purchase Program • Generous Paid Time Off • Flexible Spending Accounts • Wellness Program To
Salary is negotiable depending on the # of years clinical experience you have. To learn more about this great opportunity please email your resume along with salary requirements.
Salary : $195,000 – $255,000