Job description
- Conduct medical necessity review on cases that may not meet criteria, and issues adverse determinations as needed.
- Achieves Service Level Agreement (SLA) metrics and performance guarantees as required by health plan clients
- Ability to work up to 20 hours a week (including weekends/holidays)
- Other duties as appropriate
- MD or DO with an active and unencumbered medical licenses
- Appropriate current and unexpired specialty board certifications
- 3-5 years experience in clinical practice
- 3-5 years experience doing utilization review
- Prior experience utilizing evidence-based clinical guidelines (e.g., Milliman/Interqual) is preferred.
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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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