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Job ID 2109613
Job Description
Join our dynamic team where you will play a crucial role in evaluating the medical necessity of healthcare services that may not align with established utilization review criteria within the United States. Your expertise will be pivotal as you conduct thorough reviews for appeals related to denied services, utilizing your current medical experience and adhering to established appeal policies when delegated.
Engage in meaningful peer-to-peer discussions with referring physicians, clarifying clinical details and explaining the rationale behind review outcomes. It’s essential to maintain your credentials actively and promptly notify eviCore of any changes to your medical licenses or board certifications.
Your involvement will extend to strategic planning and evaluation for Care Management, ensuring that we continually enhance our healthcare delivery.
We seek a candidate who is an M.D. or D.O. with a valid U.S. state medical license and board certification in Oncology Radiation recognized by the American Board of Medical Specialties (ABMS). Recent direct patient care experience within the last 18 months is necessary, alongside a minimum of 5 years of clinical experience post-residency or fellowship. Familiarity with relevant state and federal regulations, URAC and NCQA standards is a plus, as is proficiency in automated processes and computer systems.
Enjoy a balanced lifestyle with predictable scheduling—our positions do not require night or weekend shifts, and there is no on-call duty. We offer both full-time and part-time opportunities along with a competitive salary and robust benefits package.
At eviCore Healthcare, we are dedicated to making a positive impact in the healthcare sector and fostering a supportive environment for our employees. Our benefits include:
- Flexible work schedules and options for remote work to promote a healthy work/life balance.
- Starting at 4 weeks of paid time off (PTO) annually, plus paid holidays.
- One week of Continuing Medical Education (CME) each year.
- Education assistance, tuition reimbursement, and support for professional certifications.
- Comprehensive health, dental, and vision coverage, in addition to life insurance with employer-funded Health Savings Account (HSA).
- Paid Volunteer Community Service Days.
- Abundant opportunities for professional growth, advancement, and promotions.
- A 401k retirement plan with a 50% match on employee contributions up to 6%.
eviCore is committed to building and retaining a diverse workforce and is an Equal Opportunity Employer. We welcome candidates without regard to race, color, religion, sex, national origin, age, veteran status, disability, or any other protected class. Successful candidates must be able to pass drug screening and background checks.