Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States.
Reviews appeals for denied services related to current relevant medical experience or knowledge in accordance with appeal policies, if so delegated.
Provides timely peer-to-peer discussions with referring physicians to clarify clinical information and to explain review outcome decisions.
Maintains necessary credentials and immediately informs eviCore of any adverse actions relating to medical licenses and / or board certifications.
Participates in strategic planning for and evaluation of the Care ManagementThe successful candidate will be an M.D. or D.
O. with a current, active, U.S. state medical license and board certified in Gastroenterology, recognized by the American Board of Medical Specialties (ABMS), with recent practice experience in direct patient care (within the past 18 months).
Must have a minimum of 5 years clinical experience, beyond residency / fellowship Knowledge of applicable state and federal laws, URAC and NCQA standards a plus, and familiarity with automated processes and computer applications and systems is requiredNo nights, no weekends, not call.
Predictable work scheduleFull and part time opportunitiesSalaried position with benefitsSupportive organization with collaborative cultureeviCore healthcare is committed to making a positive impact on healthcare, and also making a positive impact on our employees.
eviCore offers a variety of perks and benefits including, but not limited to : Flexible scheduling and work / life balance with remote and work from home opportunities4 weeks of PTO(starting) per year plus paid holidaysOne week of CMEEducation assistance, tuition reimbursement and professional certifications Health, dental, vision, and life benefits with employer funded HSAPaid Volunteer Community Service Days Ample opportunities for growth, advancement, and promotion 401k retirement plan with company match of 50% employee contributions up to 6% eviCore is committed to hiring and retaining a diverse workforce.
We are an Equal Opportunity Employer, making decisions without regard to race, color, religion, sex, national origin, age, veteran status, disability, or any other protected class.
Applicants must be able to pass a drug test and background investigation
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