Utilization Mgmt Physician - R0010289 (20243288)
HealthCare Partners is looking for Utilization Management Review Physician to join our Utilization Management team. The clinicians we seek are those who practice medicine with a focus on patient care, not volume. We want our clinicians to take the time needed to truly address the patient’s needs.
HealthCare Partners offers competitive pay with financial incentives for yielding strong metrics on quality care while seeing a lower than average census. We provide our clinicians an excellent benefit package which includes leadership pathways, CME reimbursement, paid license renewals and many other benefits, charitable sponsorships, and volunteer opportunities.
If you’re looking to join a physician-led community that is making a difference in healthcare, HealthCare Partners is the place for you. Our initial on-line application process will take you less than two minutes to complete!
- Responsible for timely review of requests for service; performing post service / claims review and make determination based on medical necessity and appropriateness of care within established guidelines.
- Adhere to regulatory, health plan, and clinical guidelines for denials.
- Identify utilization trends and work with Regional leadership team when interventions are indicated.
- Work collaboratively with UM Review Physicians and Care Management team.
- Attend monthly Utilization Management meeting for region.
- Position will cover designated region; travel to multiple sites and regional office based in Arcadia.
- Position is 0.8 FTE, 32 hours per week.
- Unrestricted CA Medical License
- Current CA DEA certificate required prior to start date
- Current Board Certification
- Minimum five years clinical experience
- Minimum 2 - 3 years’ experience in medical group, health plan setting; claims review (including all specialties) and utilization.
- Excellent working knowledge of CMS regulations
- Knowledge of health plan and regulatory requirements
- Proficient with CPT and ICD-10 codes
- Excellent oral and written communication skills
- Ability to work independently in team oriented environment
- Computer proficient
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. Optum brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Here you’ll find incredible ideas in one incredible company and a singular opportunity to do your life's best work.(SM)
Diversity creates a healthier atmosphere: Optum and its affiliated medical practices are Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Optum and its affiliated medical practices is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.