Physician Reviewer

This is a fully remote position, open to applicants in California.

📋 Description

• Perform regular assessments of authorization requests across all business lines, utilizing relevant national and state health plans as well as established guidelines.

• Grant authorizations in accordance with delegation responsibilities, the AltaMed Authorization Matrix, training, and licensing limitations.

• Handle authorization denials by employing standard denial language and posting recommendations in the authorization platform.

• Evaluate and provide recommendations for retro claims related to outpatient authorizations, inpatient authorizations, and emergency room claims.

• Engage in ad hoc projects while analyzing high-cost utilization, unmanaged care, inappropriate utilization, billing practices, and budgeting/financial reporting.

• Identify high-risk populations and direct patients to suitable case management programs.

• Offer oversight, guidance, and training to UM nurse reviewers and other UM personnel when necessary.

• Deliver case management services to hospitalized patients and those requiring ambulatory case management.

• Collaborate in interdisciplinary care coordination with social work, mental health counseling, psychosocial support, in-home assistance, legal services, skilled nursing, and home health teams.

⛳️ Requirements

• MD/DO degree.

• Completion of a Physician Training Program.

• Graduation from an accredited medical training institution.

• Valid BLS certification or higher, adhering to American Heart Association (AHA) or American Red Cross guidelines.

• Board Certification is preferred.

🏝️ Benefits

• Medical, Dental, and Vision insurance.

• 403(b) Retirement savings plans with employer matching contributions.

• Flexible Spending Accounts.

• Commuter Flexible Spending.

• Opportunities for Career Advancement & Development.

• Paid Time Off & Holidays.

• Paid CME Days.

• Malpractice insurance and tail coverage.

• Tuition Reimbursement Program.

• Corporate Employee Discounts.

• Employee Referral Bonus Program.

• Pet Care Insurance.

• Discretionary bonuses or incentives may apply.