• Provides medical interpretation and determinations for services by healthcare professionals
• Supports team members, departments, and Regional VP Health Services
• Conducts computer-based review of clinical scenarios
• Reviews submitted clinical records and prioritizes daily work
• Communicates decisions to internal associates and may participate in care management

Requirements

MD or DO degree
5+ years of direct clinical patient care experience post residency or fellowship, preferably in an inpatient environment and/or related to care of a Medicare type population
Current and ongoing Board Certification in an approved ABMS Medical Specialty
A current and unrestricted license in at least one jurisdiction
No current sanction from Federal or State Governmental organizations
Excellent verbal and written communication skills
Evidence of analytic and interpretation skills, with prior experience in quality management, utilization management, case management, discharge planning, and/or home health or postacute services

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Hard Skills

clinical interpretation
quality management
utilization management
case management
discharge planning
home health services
postacute services

Soft Skills

verbal communication
written communication
analytical skills
interpretation skills
team support

Certifications & Qualifications

MD degree
DO degree
Board Certification
unrestricted medical license

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