Internal Medicine Physician for Utilization Review - San Diego, Califo

Company: Integrity Healthcare
Location: San Diego
Posted on: February 22, 2021

Job Description:

Looking for someone who has experience with weekly chart review and human resource evaluations and assessing untoward outcomes of medical decisions specifically for Medical groups/Healthplans. Looking at someone that could potentially transition to CMO/VP position in the next 3-5 years Summary The Physician Reviewer will perform all reasonably necessary functions to ensure quality of care and appropriate utilization in the most cost-effective, appropriate and professional manner, which meets the expressed needs of patients and professional colleagues.

• Physician Reviewer will be a part of the Health Services Department. This department is comprised of areas of Medical Management, Provider Relations/Network Support, Quality Improvement and Pharmacy. Award-winning network of hospitals, medical groups and physicians. We offer health insurance options for individuals, families, groups and businesses that combine affordability, choice, high-quality health care and personal service. Required Skills and Qualifications

• M.D. Degree
• License to practice in California must be in hand or in progress
• Five years experience as a practicing primary care physician with knowledge of managed care and the process for prior authorization review
• Knowledge of physician social and political behavior and managed care philosophy
• Effective communication skills
• Ability to work collaboratively with medical leadership and administration, medical staff, nurses, and hospital administration.
• Board Certification in Internal Medicine or Family Medicine Hours 8-hour shift: 8:00 am - 5:00 pm, weekends as needed. To be considered, candidates need to be able to answer yes to at least 3 of these criteria: - Experience at a Healthplan - Committee membership for quality of care or peer review leadership experience - Experience doing peer to peer calls - Experience doing appeals and/or grievances - Experience doing utilization reviews for care (determining approval or denial of care) - Experience writing medical or clinical policies Keyphrases: internal medicine jobs, internal emergency medicine jobs, internal medicine specialist jobs, internal medicine critical care jobs, internal medicine geriatrics jobs, internal medicine pediatrics jobs, pediatric internal medicine jobs

Keywords: Integrity Healthcare, San Diego , Internal Medicine Physician for Utilization Review - San Diego, Califo, Healthcare , San Diego, California