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Physician - Administration - Management Job in Arcadia, CA

Utilization Mgmt Physician

Davita Medical Group

Arcadia, CA 91006

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.

Position Details: 

  • 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

Requirements:

  • 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
HealthCare Partners - Arcadia Logo
HealthCare Partners - Arcadia450 E. Huntington Dr.Arcadia, CA 91006
Contact Information
Brad Jones ImageBrad JonesPhysician Recruiter - San Gabriel ValleyDavita Medical GroupEl Segundo, CA 90245
Work:(310) 252-8688
Work (alt):
Fax:
Type Of Employer:In-House
Agency Information:Not Specified