This job is paid on an hourly basis for part-time work of 20-30 hours per week.
The selected candidate may telecommute from within the state of MA.
Responsible for supporting the medical management staff ensuring timely and consistent medical decisions to members and providers. Primary duties may include, but are not limited to:
Ensures timely completion of clinical case reviews for their board certified specialty.
Makes physician to physician calls to gather medical appropriate information in order to make medical necessity determinations for services requested.
Makes medical necessity determinations for grievance and appeals appropriate for their specialty.
Ensures consistent use of company medical policies when making medical necessity decisions.
Brings to their supervisors attention, any case review decisions that require Medical Director review or policy interpretation.
Requires an MD or DO
1 year of experience with clinical case reviews for medical necessity.
Current ABMS Board certification in a medical specialty required.
Current, unrestricted license to practice medicine in the Commonwealth of Massachusetts required.
Title: MD - Physician Advisor Senior - 122180
Requisition ID: 122180
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