Job Description

Overview The Physician Reviewer provides support in clinical decision-making oversight and physician level guidance in quality management, utilization management, and care management. The Physician reviewer supports all IEHP departments in meeting the regulatory requirements set forth by the various government agencies. The Physician Reviewer shall perform Medical Review activities and provide IEHP Medical Director support. The Physician Reviewer shall perform determinations, communicate medical necessity reviews and support IEHP Medical Director(s) as needed or requested by IEHP. Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation. Education & Requirements Five (5) years or more of post-residency experience in a recognized medical specialty required Medical Director for an IPA, medical group, or HMO highly desirable Utilization management experience is a plus Primary Care Physician in internal medicine, family practice, or pediatrics preferred At least one (1) year of medical leadership experience preferred Doctor of Medicine or Psy.D from an accredited institution required Certification by one (1) of the American Specialty Boards required Possession of an active, unrestricted, and unencumbered Physician’s and Surgeon’s Certificate issued by the State of California Medical Board or a Clinical Psychologist License issued by the California Board of Psychology required A physician certified in a state other than California may be employed prior to receipt of California certification provided that an application for a California physician and surgeon’s certificate is filed in the state of California prior to date of appointment Key Qualifications Strong knowledge of: Medical and CMS regulations Administrative practices and procedures including but not limited to quality assessment and improvement, utilization review, peer review, credentialing and risk management Rules, regulations, policies, and standards related to managed care Principles of effective supervision and organization Methods, techniques, practices, principles, and literature in the broad field of medical sciences Overview of the highly specialized techniques, procedures, and equipment used in the medical or surgical specialties Microcomputer applications such as Microsoft Office, Word, Excel, and Access helpful. Strong communication skills Ability to create and maintain positive working relationships While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; talk or hear; and taste or smell The employee must occasionally lift or move up to 25 pounds Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus Start your journey Start your journey towards a thriving future with IEHP and apply TODAY! Pay Range $105.79 USD Hourly - $165.00 USD Hourly Seniority level Mid-Senior level Employment type Part-time Job function Health Care Provider Industries Hospitals and Health Care #J-18808-Ljbffr IEHP

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