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Responsibilities:
- Conducts medical necessity reviews and peer to peer consultations within regulatory turnaround times.
- Provides guidance to associates on clinical issues and case reviews related to authorization requests.
- Collaborates with Health Plan clinical leadership as requested and achieves SLA metrics.
Qualifications:
- MD or DO with active and unencumbered medical license and ABIM or ABMS board certification.
- Minimum 5 years clinical practice and 3 years utilization management experience.
- Expertise in Home Health, DME, sleep fields, and payer UM standards.
What We Offer:
- Pay range $240,000 – $280,000/year plus corporate bonus incentive.
- Paid Flex Time Off (FTO), 401K Savings Plan, Paid Parental Leave.
- Benefits: Medical, Dental, Vision, 401(k) with match, HSA, DCFSA, and more.
CareCentrix
CareCentrix provides clinical oversight and utilization management for home health, DME, home infusion therapy, and sleep medicine services. The company has an award-winning culture that values care, integrity, excellence, and innovation, operating with a drug-free workplace and equal opportunity commitment.