HealthCare Partners Medical Group is looking for Utilization Management Review Physician to join our Utilization Management team. We are aiming to find a person with very strong persuasive communication skills, a strong grasp of the big picture in healthcare economics as well as capacity to learn our complex networks.
- Responsible for timely review of requests for service; performing post service / claims review and make determination based on medical necessity and appropriateness of care within established guidelines.
- Adhere to regulatory, health plan, and clinical guidelines for denials.
- Identify utilization trends and work with Regional leadership team when interventions are indicated.
- Work collaboratively with UM Review Physicians and Care Management team.
- Attend monthly Utilization Management meeting for region.
- Position will cover designated region; travel to multiple sites and regional office based in Arcadia.
- Unrestricted CA Medical License
- Current CA DEA certificate required prior to start date
- Current Board Certification
- Minimum five years clinical experience
- Minimum 2 - 3 years’ experience in medical group, health plan setting; claims review (including all specialties) and utilization.
- Excellent working knowledge of CMS regulations
- Knowledge of health plan and regulatory requirements
- Proficient with CPT and ICD-10 codes
- Excellent oral and written communication skills
- Ability to work independently in team oriented environment
- Computer proficient
If you’re looking to join a physician-led community that is making a difference in healthcare, HealthCare Partners Medical Group is the place for you. We provide our clinicians an excellent benefit package which includes leadership pathways, CME reimbursement, paid license renewals and many other benefits, charitable sponsorships, and volunteer opportunities. Our initial on-line application process will take you less than two minutes to complete!