Das ist der Job
Aid and act as a resource to Initial Clinical Reviewers.
Darum lohnt es sich
Currently seeking Otolaryngologist Physicians to join our Radiology department
As an FMD, Radiology you will be a key member of the utilization management team.
You will have the opportunity to make a meaningful impact on patient lives in a non‑clinical environment, while enjoying better work‑life balance on a collaborative team that values continuous learning and improved health outcomes.
Collaboration Opportunities Routinely interacts with leadership and management staff, other Physicians, and staff whenever a physician’s input is needed or required.
What You’ll Be Doing Serve as the Physician match reviewer in Imaging cases that do not initially meet the applicable medical necessity guidelines, and review other imaging requests when providers, clients, or state laws require specialty reviews.
Discuss determinations (peer‑to‑peer phone calls) with requesting physicians or ordering providers within the regulatory timeframe of the request and provide clinical rationale for standard and expedited appeals.
Utilize medical/clinical review guidelines and parameters to assure consistency in the MD review process, reflecting appropriate utilization and compliance with our policies and procedures, as well as URAC and NCQA guidelines. Ensure documentation of all communications with medical office staff and/or MD provid
