Are you a BC MD or DO BC by an Approved ABMS Board in Psychiatry (and familiar with Medicare patients) who is ready for a change?
This is and outstanding opportunity for someone who is interested in working a Utilization Review role in the Las Vegas region. It is required you have a Nevada license that is in good standing. It is a plus if you have Medical Director experience or even experience working with a health plan company.
5+ years experience working in a behavioral health managed care setting or a behavioral health clinic settings. Shall have appropriate training and expertise in general psychiatry and/or addiction disorder.You must be an actively practicing physician. Previous experience within a managed care organization is preferred. Course work in the areas of Health Administration, Health Financing, Insurance, and/or Personnel Management is preferred. Experience treating or managing care for a culturally diverse population preferred.
License/Certifications: Board certified by the American Board of Psychiatry and Neurology. Current state medical license without restrictions.
Client is willing to offer nationwide relocation.
This is an opportunity that will allow you to use all your years of clinical knowledge giving back in which you would be working for a health plan advising on the best care for patients through case reviews and peer to peer reviews.
In this role you will :
To be considered for this role, you must still be in direct patient care practice.
- report to the VP of Medical Affairs
- working in office as a medical Director and one day a week in clinical practice working in either your own practice or in an under served community.
- In addition to doing utilization management activities, but also medical review activities pertaining to utilization review, quality assurance, medical review of complex, and controversial or experimental medical services such as transplants utilizing the services of consultants
- Operate in accordance with regulatory, state, corporate, and accreditation requirements.
- Identify unusual provider practice patterns, and adequacy of benefit/payment components
- Assist in reducing unwarranted variation in clinical practice in order to improve the quality and cost of care.
- Reviews claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment
Our client offers a robust benefits package which includes:
• Competitive pay • Health, Vision and Dental Benefits • Life Insurance • Tuition Reimbursement • 401 (k) Retirement Program • Employee Stock Purchase Program • Generous Paid Time Off • Flexible Spending Accounts • Wellness Program To
learn more about this great opportunity please email your resume along with salary requirements.
Salary is negotiable depending on the # of years clinical experience you have. To learn more about this great opportunity please email your resume along with salary requirements.