HealthCare Partners Medical Group is looking for Utilization Management Review Physician to join our Utilization Management team. We are aiming to find a person with very strong persuasive communication skills, a strong grasp of the big picture in healthcare economics as well as capacity to learn our complex networks.
- Responsible for timely review of requests for service; performing post service / claims review and make determination based on medical necessity and appropriateness of care within established guidelines.
- Adhere to regulatory, health plan, and clinical guidelines for denials.
- Identify utilization trends and work with Regional leadership team when interventions are indicated.
- Work collaboratively with UM Review Physicians and Care Management team.
- Attend monthly Utilization Management meeting for region.
- Position will cover designated region; travel to multiple sites and regional office based in Arcadia.
- Position can be full time, part time or per diem
- Unrestricted CA Medical License
- Current CA DEA certificate required prior to start date
- Current Board Certification
- Minimum five years clinical experience
- Minimum 2 - 3 years’ experience in medical group, health plan setting; claims review (including all specialties) and utilization.
- Excellent working knowledge of CMS regulations
- Knowledge of health plan and regulatory requirements
- Proficient with CPT and ICD-10 codes
- Excellent oral and written communication skills
- Ability to work independently in team oriented environment
- Computer proficient