Physician Reviewer (Remote, Full-Time)
Must be an Internal Medicine or Family Medicine Physician Physician
Must reside in CT, MA, RI, NH, VT, ME or NY
- Join a wonderful, not for profit health plan!
- Fully remote
- No call, no nights, no weekends, no holidays!
- 40 hours per week, Monday thru Friday 8:30a-5p
- $250K plus very strong benefits (ie. 6 weeks’ vacation, 401k match, etc.)
About the position:
- Under the general direction of the Vice President of Clinical Affairs, performs medical case review of services subject to approval under the Connecticut Medical Assistance Program (CMAP).
- Engages in telephonic case review and discussion with providers.
- Participates and contributes actively in medical matters related to utilization management, case management, peer review, quality improvement and other processes requiring medical/clinical leadership and consultation.
- Responds to inquiries from providers, internal stakeholders, and Department of Social Services as necessary.
- Serves as a resource to clinical staff.
- Provides recommendations for improving care delivery and health outcomes for CMAP enrollees.
- Participates in activities specific to contractual requirements such as Fair Hearings, etc.
- Appropriately documents case review findings, actions, and outcomes in keeping with established policies.
- Collaborates with clinical staff to implement clinical and quality management programs and initiatives. Interacts with providers and vendors regarding clinical care and services for CMAP enrollees.
- Actively participates and contributes in medical review team meetings; participates in design and development of care programs and quality improvement initiatives as requested.
- Proactively shares resources, information and guidelines related to quality, cost-effective health care delivery.
What we’re looking for:
- MD or DO – licensed in CT or willing to become licensed in CT
- Board Certified in either Internal Medicine or Family Medicine
- Experience in utilization review preferred, but not required (will train)
- Experience with Medicaid population strongly preferred
Pay: $250,000.00 per year
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Flexible schedule
- Flexible spending account
- Health insurance
- Life insurance
- Paid time off
- Retirement plan
- Vision insurance
Application Question(s):
- Are you comfortable working remotely? This is a remote position.
- What is your medical specialty?
- Do you reside in CT, MA, RI, NH, VT, ME or NY? This is a requirement.
Experience:
- practicing physician: 5 years (Required)
License/Certification:
- MD or DO license? (Required)
Work Location: Remote
