Physician Clinical Reviewer- Gastroenterology
Physician Clinical Reviewer- Gastroenterology at Evolent Health in Boise, Idaho, United States Job Description Your Future Evolves Here Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions.
Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones.
Evolent employees enjoy work / life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done.
We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work.
That's one reason why diversity and inclusion are core to our business. Join Evolent for the mission. Stay for the culture.
What You'll Be Doing : As a Physician Clinical Reviewer, RBM you will be a key member of the utilization management team.
We can offer you a meaningful way to make a difference in patients' lives, in a non-clinical environment. You can enjoy better work- life balance on a team that values collaboration and continuous learning while providing better health outcomes.
Collaboration Opportunities : + Routinely interacts with leadership and management staff, other Physicians, and staff whenever a physician s input is needed or required.
Aids and acts as a resource to Initial Clinical Reviewers. What You Will Be Doing : + Serve as the Clinical Reviewer in Imaging cases, that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert.
- Discusses determinations (peer to peer phone calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request.
- Utilizes medical / clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU s policies / procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines.
- Provides clinical rationale for standard and expedited appeals. + Ensures documentation of all communications with medical office staff and / or MD provider is recorded in a timely and accurate manner.
- Participates in on-going training per inter-rater reliability process. + On a requested basis, may function as Medic To view full details and how to apply, please login or create a Job Seeker account
Physician Clinical Reviewer- Gastroenterology
Physician Clinical Reviewer- Gastroenterology at Evolent Health in Boise, Idaho, United States Job Description Your Future Evolves Here Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. What You'll Be Doing: As a Ph...
Cardiology Physician Clinical Reviewer
What You’ll Be Doing:As a Cardiology, Physician Clinical Reviewer you will be a key member of the utilization management team. Collaboration Opportunities:Routinely interacts with leadership and management staff, other Physicians, and staff whenever a physician`s input is needed or required. As well...
Physician Clinical Reviewer- GI - REMOTE
Routinely interacts with physicians, leadership and management staff, other Physician Clinical Reviewers (PCR), and health plan members and staff whenever a physician`s input is needed or required. Physician Clinical Reviewer- GI - REMOTE at Prime Therapeutics in Boise, Idaho, United States Job Desc...
Physician Clinical Reviewer-Interventional Pain Management
What You’ll Be Doing:As a Physician Clinical Reviewer, Interventional Pain Management, you will be a key member of the utilization management team. What You Will Be Doing:Serve as the Physician Clinical Reviewer for Interventional Pain Management, reviewing cases that do not initially meet the appli...
Physician Clinical Reviewer, Radiation Oncology
You will be a key member of the utilization management team and routinely interact with physicians, leadership, management staff and other Physician Clinical Reviewers (PCR's) whenever a physician`s input is needed or required. As a Radiation Oncology Physician Clinical Reviewer, you'll use your cli...
Urology- Physician Clinical Reviewer
What You’ll Be Doing:As a Physician Clinical Reviewer you will be a key member of the utilization management team. Qualifications - Required and Preferred:MD/DO/MBBS- RequiredMinimum of five (5) years’ experience in the practice of Medicine, post residency and Active Clinical practice within the las...
Nurse Practitioner-Boise ID
We are looking for the right Nurse Practitioner to perform medical assessments on United States Veterans as part of the VA's disability benefits process. The Nurse Practitioner DOES NOT make disability determinations. Must hold a current and unrestricted Nurse Practitioner or Physician Assistant lic...
Hospitalist
Hospitalist physician job in Idaho :. Join a team of Hospitalists at a level III trauma center located just minutes from Boise, ID. ...
Travel Medical Assistant - $1040 / Week
Uniti Med is seeking an experienced Medical Assistant for an exciting Travel Allied job in Boise, ID. Uniti Med provides career opportunities to healthcare professionals by aiding medical facilities to fill their staffing needs. ...
Travel Registered Nurse - Labor/Delivery - $2,102 / week
Once a nurse selects an assignment of their choice, we then empower the nurses with an easy profile generator allowing nurses to submit themselves for an interview with confidence knowing they've booked an open job with the pay and location of their choice. Stability displays to their nurses the bes...