Remote Utilization Review- Orthopedic Surgeon

Full time PRN in Health Care , in Physicians & Surgeons Email Job
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Job Detail

    Job Description

    This client is an intelligent care management company – through its unique position at the heart of patients, providers, and plans – committed to making a positive impact on healthcare.

    With more than one thousand doctors and nurses amongst our experienced professionals, we have the expertise to address the perspectives and needs of all our healthcare clients. This complements an evidence-based, patient-centric healthcare management approach that allows us to integrate and apply more informed insights – prompting more focused actions, more custom services, intelligent solutions, and quality healthcare.
    overview
    Must Haves:

    1. ABMS Board Certified (MD or DO)

    2. Minimum of 5 years clinical experience (after fellowship)

    3. Has seen patients in last 18 to 24 months

    Tell Me About this Job:

    1. Intake- cases come in and filtered through AI then reviewed by non-clinical support

    team

    2. Nurse Review- cases then reviewed by nurse if outcome can’t be determined

    by non- clinical support team

    3. AMD Review- Cases are escalated to the AMD team if an outcome can’t be

    determined by nurse review

    4. AMD Review Process- cases are reviewed on portal or peer-to-peer calls to determine

    the appropriate evidence-based clinical decision

    AMDs (Assistant Medical Directors) will typically spend 50% of the day reviewing cases within an online portal and 50% conducting “peer-to-peer” (P2P) telephone calls. These calls are usually with the requesting provider, focusing on reconsideration of a denied case.

    Reasons to Love This Job:

    1. Work/ Life Balance- predictable work schedule, remote work opportunities, full and part- time opportunities available

    2. Continued support and hands on training

    3. Rewarding work in a highly collaborative and congenial environment

    4. Bonus eligibility

    Scheduling:

    – M-W-F schedule

    – Need to be able to have consistent schedule

    – 20 hours a week is minimum hours that can be worked

    – Cannot work less than 4 hours a day

    – 20+ hours a week (able to determine how many hours you would like to work, and

    choose schedule)

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