Physician / Maternal Fetal Medicine / Nationwide / Permanent / Associate Medical Director - Maternal Fetal - 100% Remote
Full Description
Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States.Reviews appeals for denied services related to current relevant medical experience or knowledge in accordance with appeal policies, if so delegated.Provides timely peer-to-peer discussions with referring physicians to clarify clinical information and to explain review outcome decisions.Maintains necessary credentials and immediately informs eviCore of any adverse actions relating to medical licenses and/or board certifications.Participates in strategic planning for and evaluation of the Care Management
Why This Role?
Anda akan bekerja secara remote dan terlibat dalam perencanaan strategis untuk manajemen perawatan.
Key Responsibilities
- Tinjau permintaan medis untuk menentukan kebutuhan medis
- Berkomunikasi dengan dokter lain untuk memahami informasi klinis
- Jelaskan keputusan review kepada dokter lain
- Tetapkan kredensial medis dan laporkan tindakan negatif
- Ikut serta dalam perencanaan strategis untuk manajemen perawatan
Requirements
- Pendidikan medis dan sertifikasi yang relevan
- Pengalaman dalam review medis dan peninjauan kebutuhan medis
- Kemampuan berkomunikasi dengan dokter lain
- Kredensial medis yang valid dan terbaru
Required Skills
View Original Description from Jobg8 (United States)
Original description from Jobg8 (United States)
Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States.Reviews appeals for denied services related to current relevant medical experience or knowledge in accordance with appeal policies, if so delegated.Provides timely peer-to-peer discussions with referring physicians to clarify clinical information and to explain review outcome decisions.Maintains necessary credentials and immediately informs eviCore of any adverse actions relating to medical licenses and/or board certifications.Participates in strategic planning for and evaluation of the Care Management
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