Premier, Inc.
Radiology Physician Reviewer - Part Time
Premier, Inc., Charlotte, North Carolina, United States, 28245
Radiology Physician Reviewer - Part Time
What you will be doing: The Physician Reviewer is responsible for processing UM requests that do not meet guidelines, processing appeals, and education of the ordering providers in peer-to-peer calls as applicable. Key Responsibilities This board-certified Radiologist will be responsible for processing Utilization Management (UM) requests, appeals, and reconsiderations as applicable.
Required to write a denial rationale in compliance with health plan and government agencies.
Required to participate in peer-to-peer conversations with requesting providers as needed.
Required to be compliant with
contractual
obligations to the health plans, government agencies, and certifications that are maintained by organization.
Required to apply clinical judgement in consideration of an individual member's clinical needs to render a utilization review determination.
Required to participate in quarterly UM meetings.
Responsible for communicating need for additional clinical information to referring/prescribing providers related to consideration for authorization or modification of a referring provider's request for radiological or diagnostic imaging services.
Responsible for coordinating with UM team to ensure timely and accurate communication of clinical decisions.
Required to complete satisfactory quarterly Inter-Rater Exams and biannual audits.
Required Certifications/Licensing - Valid and unrestricted Medical License:
NY and CA preferred, NM strongly preferred - Board Certified Radiologist Required Education: - MD, Graduate of recognized medical degree program Part Time: This role is designed to provide coverage, as needed, which could range from 0 to 40 hours per week dependent on need and scheduling, mutually agreed upon with advanced notice.
Required Qualifications Work Experience: Years of Applicable Experience - 10 or more years
Education: Professional Medical Degree (Required)
Preferred Qualifications Skills: Strong clinical, management and organizational skills.
Excellent verbal and written communications skills
Proficient computer skills
Valid and unrestricted Medical License:
NY and CA preferred, NM strongly preferred
Experience: Minimum of 10 years of experience in practice in direct patient care after graduating from medical school
Additional Job Requirements: Remain in a stationary position for prolonged periods of time
Be adaptive and change priorities quickly; meet deadlines
Attention to detail
Operate computer programs and software
Ability to communicate effectively with audiences in person and in electronic formats.
Day-to-day contact with others (co-workers and/or the public)
Making independent decisions
Ability to work in a collaborative business environment in close quarters with peers and varying interruptions
Working Conditions: Remote Travel Requirements: No travel required Physical Demands: Sedentary: Exerting up to 10 pounds of force occasionally, and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves remaining stationary most of the time. Jobs are sedentary if movement is required only occasionally, and all other sedentary criteria are met. Premier's compensation philosophy is to ensure that compensation is reasonable, equitable, and competitive in order to attract and retain talented and highly skilled employees. Premier's internal salary range for this role is $155,000 - $289,000. Final salary is dependent upon several market factors including, but not limited to, departmental budgets, internal equity, education, unique skills/experience, and geographic location. Premier utilizes a wide-range salary structure to allow base salary flexibility within our ranges. Employees also receive access to the following benefits: *Health, dental, vision, life and disability insurance *401k retirement program *Paid time off *Participation in Premier's employee incentive plans *Tuition reimbursement and professional development opportunities Premier at a glance: Ranked #1 on Charlotte's Healthiest Employers list for 2019, 2020 and 2022, and 49th Healthiest Employer in America (2022) Named one of the World's Most Ethical Companies by Ethisphere Institute for the 13th year in a row The only company to be recognized by KLAS twice for Overall Healthcare Management Consulting
Employees receive: Perks and discounts Access to on-site and online exercise classes Paid time off to volunteer in their communities
Premier is looking for smart, agile individuals like you to help us transform the healthcare industry. Here you will find critical thinkers who have the freedom to make an impact. Colleagues who share your thirst to learn more and do things better. Teammates committed to improving the health of a nation. See why incredible challenges require incredible people.
Premier is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to unlawful discrimination because of their age, race, color, religion, national origin, ancestry, citizenship status, sex, sexual orientation, gender identity, gender expression, marital status, familial status, pregnancy status, genetic information, status as a victim of domestic violence, covered military or protected veteran status (e.g., status as a Vietnam Era veteran, disabled veteran, special disabled veteran, Armed Forces Serviced Medal veteran, recently separated veteran, or other protected veteran) disability, or any other applicable federal, state or local protected class, trait or status or that of persons with whom an applicant associates. We also consider qualified applicants with criminal histories, consistent with applicable federal, state and local law. In addition, as a federal contractor, Premier complies with government regulations, including affirmative action responsibilities, where they apply.
Premier also provides reasonable accommodations to qualified individuals with a disability or those who have a sincerely held religious belief. If you need assistance in the application process, please reply todiversity_and_accommodations@premierinc.comor contact Premier Recruiting at 704.816.5200.
Information collected and processed as part of any job application you choose to submit to Premier is subject to Premier'sPrivacy Policy.
What you will be doing: The Physician Reviewer is responsible for processing UM requests that do not meet guidelines, processing appeals, and education of the ordering providers in peer-to-peer calls as applicable. Key Responsibilities This board-certified Radiologist will be responsible for processing Utilization Management (UM) requests, appeals, and reconsiderations as applicable.
Required to write a denial rationale in compliance with health plan and government agencies.
Required to participate in peer-to-peer conversations with requesting providers as needed.
Required to be compliant with
contractual
obligations to the health plans, government agencies, and certifications that are maintained by organization.
Required to apply clinical judgement in consideration of an individual member's clinical needs to render a utilization review determination.
Required to participate in quarterly UM meetings.
Responsible for communicating need for additional clinical information to referring/prescribing providers related to consideration for authorization or modification of a referring provider's request for radiological or diagnostic imaging services.
Responsible for coordinating with UM team to ensure timely and accurate communication of clinical decisions.
Required to complete satisfactory quarterly Inter-Rater Exams and biannual audits.
Required Certifications/Licensing - Valid and unrestricted Medical License:
NY and CA preferred, NM strongly preferred - Board Certified Radiologist Required Education: - MD, Graduate of recognized medical degree program Part Time: This role is designed to provide coverage, as needed, which could range from 0 to 40 hours per week dependent on need and scheduling, mutually agreed upon with advanced notice.
Required Qualifications Work Experience: Years of Applicable Experience - 10 or more years
Education: Professional Medical Degree (Required)
Preferred Qualifications Skills: Strong clinical, management and organizational skills.
Excellent verbal and written communications skills
Proficient computer skills
Valid and unrestricted Medical License:
NY and CA preferred, NM strongly preferred
Experience: Minimum of 10 years of experience in practice in direct patient care after graduating from medical school
Additional Job Requirements: Remain in a stationary position for prolonged periods of time
Be adaptive and change priorities quickly; meet deadlines
Attention to detail
Operate computer programs and software
Ability to communicate effectively with audiences in person and in electronic formats.
Day-to-day contact with others (co-workers and/or the public)
Making independent decisions
Ability to work in a collaborative business environment in close quarters with peers and varying interruptions
Working Conditions: Remote Travel Requirements: No travel required Physical Demands: Sedentary: Exerting up to 10 pounds of force occasionally, and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves remaining stationary most of the time. Jobs are sedentary if movement is required only occasionally, and all other sedentary criteria are met. Premier's compensation philosophy is to ensure that compensation is reasonable, equitable, and competitive in order to attract and retain talented and highly skilled employees. Premier's internal salary range for this role is $155,000 - $289,000. Final salary is dependent upon several market factors including, but not limited to, departmental budgets, internal equity, education, unique skills/experience, and geographic location. Premier utilizes a wide-range salary structure to allow base salary flexibility within our ranges. Employees also receive access to the following benefits: *Health, dental, vision, life and disability insurance *401k retirement program *Paid time off *Participation in Premier's employee incentive plans *Tuition reimbursement and professional development opportunities Premier at a glance: Ranked #1 on Charlotte's Healthiest Employers list for 2019, 2020 and 2022, and 49th Healthiest Employer in America (2022) Named one of the World's Most Ethical Companies by Ethisphere Institute for the 13th year in a row The only company to be recognized by KLAS twice for Overall Healthcare Management Consulting
Employees receive: Perks and discounts Access to on-site and online exercise classes Paid time off to volunteer in their communities
Premier is looking for smart, agile individuals like you to help us transform the healthcare industry. Here you will find critical thinkers who have the freedom to make an impact. Colleagues who share your thirst to learn more and do things better. Teammates committed to improving the health of a nation. See why incredible challenges require incredible people.
Premier is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to unlawful discrimination because of their age, race, color, religion, national origin, ancestry, citizenship status, sex, sexual orientation, gender identity, gender expression, marital status, familial status, pregnancy status, genetic information, status as a victim of domestic violence, covered military or protected veteran status (e.g., status as a Vietnam Era veteran, disabled veteran, special disabled veteran, Armed Forces Serviced Medal veteran, recently separated veteran, or other protected veteran) disability, or any other applicable federal, state or local protected class, trait or status or that of persons with whom an applicant associates. We also consider qualified applicants with criminal histories, consistent with applicable federal, state and local law. In addition, as a federal contractor, Premier complies with government regulations, including affirmative action responsibilities, where they apply.
Premier also provides reasonable accommodations to qualified individuals with a disability or those who have a sincerely held religious belief. If you need assistance in the application process, please reply todiversity_and_accommodations@premierinc.comor contact Premier Recruiting at 704.816.5200.
Information collected and processed as part of any job application you choose to submit to Premier is subject to Premier'sPrivacy Policy.