Job Description

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The Opportunity
Description

• Evaluates clinical service requests made by an organization's members and providers.
• Uses clinical judgment in conjunction with organization's criteria to adjudicate these requests.
• Provides clinical leadership in other areas of the organization.
• Identifies opportunities to manage members' clinical situations with a view toward creative problem solving and anticipation of possible future clinical problems for the member.
• Participates in the process to evaluate clinical service requests.
• Practices anticipatory case management for members whose cases come for review, in partnership with case managers.
• Participates in the Physician Review Units' appeal process of service denials.
• Participates in the development of Physician Review Units' policies and procedures.
• Actively participates in all unit continuous quality improvement activities.

Our Client

Our client is a fast-growing industry-recognized staffing firm. Recruiting critical IT, Financial, Engineering, Healthcare, and Data Analytics talent. With 20+ years' experience and growth.

Connections in Automotive, Healthcare, Retail, Financial & Insurance, and Professional & Business Services. Working to bring top talent together with premier organizations.

Big enough to have great opportunities. Small enough to care about finding the right one for you.

It'sabout relationships based on mutual interest. The results are low turnover, long-lasting partnerships and growth. Want to work for a company invested in your success?

Experience Required for Your Success

• Board Certified (ABMS) M.D. or D.O, unrestricted and active license to practice medicine requested
• 5 years clinical experience to include inpatient experience, or any combination of education/experience that would provide an equivalent background
• Understanding of managed care and demonstrate PC proficiency, as file review will be done via computer in most cases
• REMOTE weekend work - at least 2 weekends per month

What Do You Think?
Does your experience reflect what it takes to be successful in this role? Do the work and challenges get you excited about what's possible? PSG Global Solutions Careers

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