18 jobs found

Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States.Reviews appeals for denied services related to current relevant medical experience or knowledge in accordance with appeal policies, if so delegated.Provides timely peer-to-peer discussions with referring physicians to clarify clinical information and to explain review outcome decisions.Maintains necessary credentials and immediately informs eviCore of any adverse actions relating to medical licenses and/or board certifications.Participates in strategic planning for and evaluation of the Care ManagementThe successful candidate will be an M.D. or D.O. with a current, active, U.S. state medical license and board certified in Cardiology, recognized by the American Board of Medical Specialties (ABMS), with recent practice experience in direct patient care (within the past 18 months).Must...

Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States.Reviews appeals for denied services related to current relevant medical experience or knowledge in accordance with appeal policies, if so delegated.Provides timely peer-to-peer discussions with referring physicians to clarify clinical information and to explain review outcome decisions.Maintains necessary credentials and immediately informs eviCore of any adverse actions relating to medical licenses and/or board certifications.Participates in strategic planning for and evaluation of the Care ManagementThe successful candidate will be an M.D. or D.O. with a current, active, U.S. state medical license and board certified in Neurology, recognized by the American Board of Medical Specialties (ABMS), with recent practice experience in direct patient care (within the past 18 months).Must...

Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States.Reviews appeals for denied services related to current relevant medical experience or knowledge in accordance with appeal policies, if so delegated.Provides timely peer-to-peer discussions with referring physicians to clarify clinical information and to explain review outcome decisions.Maintains necessary credentials and immediately informs eviCore of any adverse actions relating to medical licenses and/or board certifications.Participates in strategic planning for and evaluation of the Care ManagementThe successful candidate will be an M.D. or D.O. with a current, active, U.S. state medical license and board certified in Surgery - Orthopedics, recognized by the American Board of Medical Specialties (ABMS), with recent practice experience in direct patient care (within the past 18...

Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States.Reviews appeals for denied services related to current relevant medical experience or knowledge in accordance with appeal policies, if so delegated.Provides timely peer-to-peer discussions with referring physicians to clarify clinical information and to explain review outcome decisions.Maintains necessary credentials and immediately informs eviCore of any adverse actions relating to medical licenses and/or board certifications.Participates in strategic planning for and evaluation of the Care ManagementThe successful candidate will be an M.D. or D.O. with a current, active, U.S. state medical license and board certified in Gastroenterology, recognized by the American Board of Medical Specialties (ABMS), with recent practice experience in direct patient care (within the past 18...

Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States.Reviews appeals for denied services related to current relevant medical experience or knowledge in accordance with appeal policies, if so delegated.Provides timely peer-to-peer discussions with referring physicians to clarify clinical information and to explain review outcome decisions.Maintains necessary credentials and immediately informs eviCore of any adverse actions relating to medical licenses and/or board certifications.Participates in strategic planning for and evaluation of the Care ManagementThe successful candidate will be an M.D. or D.O. with a current, active, U.S. state medical license and board certified in Oncology, recognized by the American Board of Medical Specialties (ABMS), with recent practice experience in direct patient care (within the past 18 months).Must have...

Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States.Reviews appeals for denied services related to current relevant medical experience or knowledge in accordance with appeal policies, if so delegated.Provides timely peer-to-peer discussions with referring physicians to clarify clinical information and to explain review outcome decisions.Maintains necessary credentials and immediately informs eviCore of any adverse actions relating to medical licenses and/or board certifications.Participates in strategic planning for and evaluation of the Care ManagementThe successful candidate will be an M.D. or D.O. with a current, active, U.S. state medical license and board certified in Oncology Radiation, recognized by the American Board of Medical Specialties (ABMS), with recent practice experience in direct patient care (within the past 18...

Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States.Reviews appeals for denied services related to current relevant medical experience or knowledge in accordance with appeal policies, if so delegated.Provides timely peer-to-peer discussions with referring physicians to clarify clinical information and to explain review outcome decisions.Maintains necessary credentials and immediately informs eviCore of any adverse actions relating to medical licenses and/or board certifications.Participates in strategic planning for and evaluation of the Care ManagementThe successful candidate will be an M.D. or D.O. with a current, active, U.S. state medical license and board certified in Maternal - Fetal Medicine, recognized by the American Board of Medical Specialties (ABMS), with recent practice experience in direct patient care (within the past 18...

Associate Medical Director in Southwest Major MetroLeadership role gives great opportunity for growth50-year history makes for a very stable opportunityFlexible hours offer an excellent quality of lifeEstablished Associate Medical Director role Organization is poised for growth and encourages your inputMajor Metro Located in the Southwest is Considered an Outdoor ParadiseAffordable housing in and around the community with new developments on the horizon and multiple highly ranked schoolsArea is a trekking, biking, and hiking heavenExtremely strong economy that continues to grow year after yearResorts, Spas, Ranches, Craft Breweries, Wineries, and a Major UniversityCost of living is 10% LOWER than the national averageSurrounded by mountains, yet the area offers excellent cycling optionsI have worked with this organization for over 7 years and have placed multiple providers. Opportunity to work with a transparent and fair organization that supports your growth. To learn more about...

Are you interested in working flexible hours, connecting with people one-on-one, and helping them re-engage with their health? At Signify Health, part of CVS Health , our mission is to build trusted relationships to make people healthier. We re hiring physician (MD/DO) contractors to conduct In-home Health Evaluations for Medicare Advantage, Medicaid, and certain commercial plan members. These visits include a medication and medical history review, as well as a physical evaluation performed in a health plan member s home. Our physician contractors can earn a competitive wage (or supplement their current income) while managing other personal and clinical commitments. You will be provided a pre-populated, patient-specific form for each evaluation, and do not prescribe medicine, order lab tests, or alter people s current treatment regimen. This is an excellent opportunity for resident physicians to earn additional income or for more seasoned physicians seeking a change of...

Enterprise Medical Recruiting is representing a community health center with nine sites throughout the Phoenix area. The center is adding a full-time BC/BE Pediatrician to their team in Surprise, Arizona ! Highlights

Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States. Reviews appeals for denied services related to current relevant medical experience or knowledge in accordance with appeal policies, if so delegated. Provides timely peer-to-peer discussions with referring physicians to clarify clinical information and to explain review outcome decisions. Maintains necessary credentials and immediately informs eviCore of any adverse actions relating to medical licenses and/or board certifications. Participates in strategic planning for and evaluation of the Care Management The successful candidate will be an M.D. or D.O. with a current, active, U.S. state medical license and board certified in Cardiology, recognized by the American Board of Medical Specialties (ABMS), with recent practice experience in direct patient care (within the past 18 months)....

Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States. Reviews appeals for denied services related to current relevant medical experience or knowledge in accordance with appeal policies, if so delegated. Provides timely peer-to-peer discussions with referring physicians to clarify clinical information and to explain review outcome decisions. Maintains necessary credentials and immediately informs eviCore of any adverse actions relating to medical licenses and/or board certifications. Participates in strategic planning for and evaluation of the Care Management The successful candidate will be an M.D. or D.O. with a current, active, U.S. state medical license and board certified in Neurology, recognized by the American Board of Medical Specialties (ABMS), with recent practice experience in direct patient care (within the past 18 months)....

Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States. Reviews appeals for denied services related to current relevant medical experience or knowledge in accordance with appeal policies, if so delegated. Provides timely peer-to-peer discussions with referring physicians to clarify clinical information and to explain review outcome decisions. Maintains necessary credentials and immediately informs eviCore of any adverse actions relating to medical licenses and/or board certifications. Participates in strategic planning for and evaluation of the Care Management The successful candidate will be an M.D. or D.O. with a current, active, U.S. state medical license and board certified in Surgery - Orthopedics, recognized by the American Board of Medical Specialties (ABMS), with recent practice experience in direct patient care (within the past...

Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States. Reviews appeals for denied services related to current relevant medical experience or knowledge in accordance with appeal policies, if so delegated. Provides timely peer-to-peer discussions with referring physicians to clarify clinical information and to explain review outcome decisions. Maintains necessary credentials and immediately informs eviCore of any adverse actions relating to medical licenses and/or board certifications. Participates in strategic planning for and evaluation of the Care Management The successful candidate will be an M.D. or D.O. with a current, active, U.S. state medical license and board certified in Gastroenterology, recognized by the American Board of Medical Specialties (ABMS), with recent practice experience in direct patient care (within the past 18...

Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States. Reviews appeals for denied services related to current relevant medical experience or knowledge in accordance with appeal policies, if so delegated. Provides timely peer-to-peer discussions with referring physicians to clarify clinical information and to explain review outcome decisions. Maintains necessary credentials and immediately informs eviCore of any adverse actions relating to medical licenses and/or board certifications. Participates in strategic planning for and evaluation of the Care Management The successful candidate will be an M.D. or D.O. with a current, active, U.S. state medical license and board certified in Oncology, recognized by the American Board of Medical Specialties (ABMS), with recent practice experience in direct patient care (within the past 18 months)....

Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States. Reviews appeals for denied services related to current relevant medical experience or knowledge in accordance with appeal policies, if so delegated. Provides timely peer-to-peer discussions with referring physicians to clarify clinical information and to explain review outcome decisions. Maintains necessary credentials and immediately informs eviCore of any adverse actions relating to medical licenses and/or board certifications. Participates in strategic planning for and evaluation of the Care Management The successful candidate will be an M.D. or D.O. with a current, active, U.S. state medical license and board certified in Oncology Radiation, recognized by the American Board of Medical Specialties (ABMS), with recent practice experience in direct patient care (within the past 18...

Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States. Reviews appeals for denied services related to current relevant medical experience or knowledge in accordance with appeal policies, if so delegated. Provides timely peer-to-peer discussions with referring physicians to clarify clinical information and to explain review outcome decisions. Maintains necessary credentials and immediately informs eviCore of any adverse actions relating to medical licenses and/or board certifications. Participates in strategic planning for and evaluation of the Care Management The successful candidate will be an M.D. or D.O. with a current, active, U.S. state medical license and board certified in Maternal - Fetal Medicine, recognized by the American Board of Medical Specialties (ABMS), with recent practice experience in direct patient care (within the...

Thank you for considering a career at Ensemble! Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country. Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference! O.N.E Purpose: Customer Obsession:  Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations. Embracing New Ideas:  Continuously innovate by embracing emerging technology and fostering a culture of creativity and...