Utilization Management Physician Lead

Job Profile:

• Trains and educates on medical review activities pertaining to utilization review, claims review, quality assurance, and medical review of complex, controversial, or experimental medical services.

Minimum Requirements

• Five years in a professional setting such as hospital, clinic, or home health environment.
• Effective communication and interpersonal skills.
• Demonstrated knowledge of CMS guidelines, health plan criteria, MCG criteria, and state, local, or federal guidelines relating to utilization management.
• Demonstrated knowledge of case management, utilization management, quality management, discharge planning, and other cost management programs.
• Possess a strong progressive and customer-focused approach to building and maintaining customer and provider relations.
• Must have or be eligible to have a current and unrestricted Nevada medical license.
• Minimum of 5 years work experience related to inpatient management, case management, utilization management, quality management, discharge planning, or other cost management.
• Board Certified in Internal Medicine, Family Practice, or other primary care specialty.
• Current Nevada DEA certificate required prior to start date.
• Current Nevada Pharmacy license required prior to start date.
• BLS/ACLS certification prior to start date.

Preferred Qualifications

• Additional management degree such as MBA, MPH a plus.