Utilization Review MD - Medical Oncology - Remote

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Location
Any US City
Salary
$200,000 - $230,000
Job Type
Direct Hire
Date
Jun 07, 2018
Job ID
2602907
Utilization Review MD - Medical Oncology - Remote

We are searching for a physician board certified in medical oncology to largest health plan provider chart and utilization review of new cases, appealed cases, or reconsiderations.  This is a home office based role, so candidates can live anywhere in the continental US.  This role has a Radiology/ Imaging focus reviewing medical ocology cases, but not strictly med oncology. Responsibilities will also include the review of imaging cases. Interested physicians must be open and flexible to both. Work hours are 8-5 M-F.  

Responsibilities:
 
  • Provides expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria 
  • Review appeals for denied services related to current relevant medical experience
  • Provide timely peer-to-peer discussions with referring physicians to clarify clinical information and to explain review outcome decisions.
  • Documents all actions related to clinical review sessions and attests to appeal review qualifications as required.
  • Maintains files of all reviews as required by law and Health Plans to retrieve reportable data
Requirements:
  • MD or DO
  • Board certified in medical oncology, or hematology/oncology
  • Active unrestricted medical license issued from a US state
  • 5+ years of current clinical experience in medical oncology or hematology oncology
  • Familiarity with URAC and NCQA standards. 
  • Familiarity with automated processes and computer applications and systems 
  • Strong communications and analytical skills