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What You Will Do:
- Conduct clinical reviews for inpatient admissions
- Serve as the primary physician reviewer for escalated cases
- Ensure all decisions are documented according to NCQA, CMS standards
You Will Be Successful If:
- You possess extensive knowledge of MCG guidelines
- You excel at working within a matrixed organization
- You have strong analytical and problem-solving skills
What You Will Bring:
- M.D. or D.O. in good standing in your state of residence
- At least 3 years in a Utilization Management role
- Strong experience with Medicare Advantage case reviews
UM
It appears to be a healthcare organization. They ensure timely and appropriate care determinations for their Medicare Advantage members.