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Physician Reviewer

Company: Volt Services Group
Location: Downers Grove
Posted on: April 4, 2021

Job Description:

Physician Reviewer in Downers Grove, IL at Volt Are you ready for a non-patient facing position? VOLT is working with one of our fantastic health care service clients for this REMOTE work opportunity!

  • 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.
  • May also provide 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.
  • (Note: Position does not provide direct patient care or medical diagnosis.) Requirements:
    • Board Certified (ABMS) M.D. or D.O, unrestricted and active license to practice medicine
    • At least 5 years of clinical experience post residency -- or any combination of education/experience that would provide an equivalent background.
    • Great computer proficiency, as file review will be done via computer in most cases.

Keywords: Volt Services Group, Downers Grove , Physician Reviewer, Healthcare , Downers Grove, Illinois

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