In this part-time contractor role, the clinician performs utilization management clinical reviews for Medicare members, including Part A and Part B cases, appeals, and quality-of-care determinations. The work also includes peer-to-peer discussions, participation in acute and post-acute clinical rounds, and serving as a clinical resource for both clinical and non-clinical staff. This is a fully remote position with a flexible schedule and a care model that uses integrated technology and data tools.
Key Responsibilities
- Perform clinical reviews for Part A, Part B, appeals, and quality-of-care cases.
- Conduct peer-to-peer discussions related to utilization management decisions.
- Participate in inter-rater reliability activities.
- Serve as a clinical resource and subject matter expert for clinical and non-clinical staff.
- Participate in acute and post-acute clinical rounds.
Required
- Active broad state medical licensure coverage.
- Experience in Medicare utilization management.
- Willingness to obtain additional state licenses.
- Comfort learning and adapting to new technologies.
Preferred
- Experience working in a technology-enabled care environment.
Benefits & Perks
- Fully remote work.
- Flexible schedule.
- Part-time contractor arrangement.