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Job ID 2109661
Job Description
Join our dynamic team as we seek an accomplished medical expert to conduct timely evaluations of service requests concerning medical necessity, specifically for cases that fall outside the standard utilization review criteria within the United States. You will play a critical role in reviewing appeals for denied services, leveraging your current and relevant medical knowledge while adhering to our defined appeal policies.
In this position, you will engage in peer-to-peer discussions with referring physicians to clarify clinical information and articulate the rationale behind review decisions. It is essential that you maintain your credentials, promptly informing eviCore of any adverse actions affecting your medical licenses or board certifications. Your insights will also contribute to the strategic planning and evaluation of Care Management initiatives within our organization.
We are specifically looking for an M.D. or D.O. with an active U.S. state medical license and board certification in Oncology, recognized by the American Board of Medical Specialties (ABMS). Recent direct patient care experience within the last 18 months, along with a minimum of five years of clinical experience post-residency/fellowship, is required. Familiarity with applicable state and federal laws, URAC, and NCQA standards, as well as proficiency in automated processes and computer systems, will be advantageous.
Enjoy the benefits of a predictable work-life balance with no nights, weekends, or on-call duties. We offer both full-time and part-time opportunities in a salaried position that comes with comprehensive benefits:
- Flexible scheduling options, promoting work/life balance with remote and work-from-home choices.
- Starting at four weeks of paid time off (PTO) annually, plus additional paid holidays.
- One week dedicated to Continuing Medical Education (CME).
- Access to education assistance, tuition reimbursement, and support for professional certifications.
- Comprehensive health, dental, vision, and life insurance benefits, supplemented by an employer-funded Health Savings Account (HSA).
- Paid Volunteer Community Service Days to give back to the community.
- Numerous opportunities for personal and professional development within a supportive, collaborative work environment.
- A 401(k) retirement plan with a generous company match of 50% on employee contributions up to 6%.
At eviCore healthcare, we are dedicated to positively impacting both the healthcare landscape and our employees’ lives. We value diversity in our workforce and are proud to be an Equal Opportunity Employer, considering all applicants without regard to race, color, religion, sex, national origin, age, veteran status, disability, or any other protected class. Please note that successful candidates must pass a drug test and background investigation.