Utilization Management Physician

Employer
Healthcare Partners Medical Group - CA
Location
Arcadia, California
Posted
Jan 11, 2019
Closes
Jan 11, 2020
Ref
1969815
Specialty
General Practice
Hours
Full Time
Position Type
Permanent
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HealthCare Partners Medical Group is looking for Utilization Management 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.

Position Details: 

  • 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.
  • Position can be full time, part time or per diem

Requirements:

  • 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!

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