Family Practice - Daytona Beach - Curative

    Curative
    Curative Daytona Beach

    2 days ago

    $170,000 - $260,000 (USD) per year *
    Description
    A large multi-specialty staff model HMO, is seeking a Utilization Management Physician (UMP). This full-time, remote position requires critical thinking skills, effective communication, and decisive judgement.

    The ideal candidate will have a working knowledge of the responsibilities listed:

    Review pre-authorization requests, initial clinical review, and concurrent clinical review cases. Review post-service clinical decisions, including claims and appeals
    Render determinations based on relevant clinical information, medical necessity determined by using evidence-based medicine, nationally recognized criteria (i.e. MCG (formally Milliman), InterQual, Centers for Medicare and Medicaid), FHCP Protocols, and the Member's FHCP Coverage Documents
    Review clinical criteria and scripts at least annually and update if necessary
    Assist the CMO in Provider education regarding treatment protocols, treatment options, etc., as appropriate
    Be available to staff to answer questions regarding cases under review
    Be available for peer-to-peer discussions of cases under initial or concurrent review either in person, by telephone, or electronically
    Meet current regulatory standards regarding pre-authorization determinations
    Be available to discuss urgent cases directly with attending provider
    For non-certification decisions, specifies the principal reason for the determination not to certify and the clinical rationale for the non-certification
    Consult with other physicians in medical specialty areas as needed
    Participate in committees at the request of the CMO

    Practitioner Requirements Practitioner must meet the following minimum requirements to serve as a Utilization Management Practitioner("UMP) for FHCP:

    MD, DO, or from an accredited medical school
    Licensed to practice medicine in the state of Florida without restriction
    Board certified
    Have three (3) to five (5) years of clinical experience in utilization review
    Knowledge and experience with managed care health plan and benefits
    Ability to provide medical knowledge to facilitate resolution of complex issues and required decisions
    Working knowledge of medical policy and application of criteria
    Agree to participate in the Interrater Reliability Tool or such other audit process to ensure consistent application of medical policy and coverage criteria


    Additional Benefits:
    Competitive salary
    Bonus opportunity
    401(K) Tax Deferred Plan
    HMO Health Benefits for provider & eligible dependents
    Group Term Life
    Group Disability
    Malpractice Insurance
    Paid Leave Time
    CME Stipend
    Licenses, Fees & Dues reimbursed
    * This salary range is an estimation made by beBee
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