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Physician - Administration - Management Job in Arcadia, CA

Utilization Mgmt Physician

  • No
  • No Response
  • No
  • Not Specified
  • 03/25/2019
  • 670827
  • R0010289

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
  • Video
  • Slideshow