Utilization Management Medical Reviewer

As a part time Utilization Management Medical Reviewer you will conduct utilization reviews for medical necessity determinations. As appropriate and when required, this position interfaces with the internal staff, Providers, and ordering physicians.

• Consults with licensed and non-licensed reviewers on clinical issues related to authorization requests.
• Conducts medical necessity review on cases that may not meet criteria, and issues adverse determinations as needed.
• Accepts and conducts peer-to-peer consultations when requested by an ordering physician after an adverse determination has been issued, adhering to required timelines and regulations
• Successfully completes and passes Inter-rater reliability testing and random case audits
• Achieves Service Level Agreement (SLA) metrics and performance guarantees as required by health plan clients
• Ability to work up to 15 hours a week (including weekends/holidays)
• Other duties as appropriate

• MD or DO with an active and unencumbered medical licenses ( in the states specific to the CareCentrix client payer account),
• Appropriate current and unexpired specialty board certifications
• 3 plus years of UM experience
• 3 plus years of clinical practice including inpatient experience
• Prior experience utilizing evidence-based clinical guidelines (e.g., Milliman/Interqual) is preferred.

What we Offer

Hourly Salary range - $150.00 to $170.00 hourly

#IDCC

CareCentrix maintains a drug-free workplace.

We are an equal opportunity employer. Employment selection and related decisions are made without regard to age, race, color, national origin, religion, sex, disability, sexual orientation, gender identification, or being a qualified disabled veteran or qualified veteran of the Vietnam era or any other category protected by Federal or State law.

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