Physician Reviewer

Work Boldly. Live Brilliantly.

At AltaMed, we don't just serve our communities, we are part of them. We have raised the expectations of what a community clinic can deliver because we think quality care is for everyone. And, we are determined to provide it no matter the challenges because this is more than a job. It's the calling of our lives and it compels us to keep moving forward.

Job Overview

The Physician Reviewer of Utilization Management will provide routine review of authorization requests from all lines of business using respective national/state, health plan, nationally recognized guidelines where appropriate to provide guidance for processing of referrals to Medical Director staff and to UM staff. Physician Reviewers may approve authorizations per delegation responsibilities in AltaMed Authorization Matrix and where applicable per restrictions of their training and licensing. Physician Reviewers will process Denials of authorizations using standard denial language noted from above hierarchy of guidelines and post recommendations in the authorization platform to inform Medical Director workflow. Physician Reviewers may review and may recommendations on retro claims reviews for outpatient authorization, inpatient authorizations, and Emergency Room claims. Physician Reviewer may be involved in ad hoc projects and analysis of high cost utilization areas, unmanaged care, inappropriate utilization, inappropriate billing practices, and budgeting/finances reporting. May be responsible for identifying high risk population via provider/clinic referral, utilization management referral, disease registry reporting mechanisms and patient self-referral and will refer high risk patients to appropriate case management program per AltaMed Case Management Policy. With the approval of the Medical Director of Medical Management, Physician Reviewers may provide oversight, guidance, and training sessions to UM nurse reviewers and other UM staff where applicable. This position will provide case management to patients who are admitted to the hospital and those patients who may need to be enrolled in ambulatory case management. The Physician Reviewer may work as part of an interdisciplinary care team participating in the coordination of care with social work and mental health counseling, psycho-social support services, in-home support, legal services, skilled nursing, home health, etc. Effectively collaborates with the hospitalist, the hospital nursing personnel, with members of the interdisciplinary care team and with the physicians in the clinic.

Minimum Requirements

1.MD/DO, Physician Training Program completed, Board Certified Preferred

2.Graduation from an accredited medical training program.

Pay Range: $208,000.00 - $280,800.00 annually

Benefits & Career Development

• Medical, Dental and Vision insurance

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

• Flexible Spending Accounts

• Commuter Flexible Spending

• Career Advancement & Development opportunities

• 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