Clinical Utilization Review Expert

About this role A healthcare organization is seeking a Physician Specialist to join its clinical operations team. This role involves evaluating medical necessity for inpatient admissions and ongoing care, supporting appeals and denials, and collaborating closely with physicians, case managers, and health plans. Key Responsibilities Evaluate medical necessity for hospital admissions and services Collaborate with attending physicians to clarify clinical documentation Support appeals and denial resolution processes Liaise between the medical team and payers Participate in peer review and utilization review meetings Communicate with clinical and non-clinical stakeholders Minimum Qualifications Medical degree (MD or equivalent) required Minimum of 2 years of clinical experience in acute care hospital settings Familiarity with ICD-10 and utilization review principles Strong English communication skills Proficient in working with EHRs, payer portals, and documentation systems High attention to detail and professional ethics What's Offered Competitive salary package Annual performance-based bonus Comprehensive training and ongoing professional development Opportunity to work remotely in a mission-driven environment

Creado: Jue, 01 de Ene de 1970