Provides Medicare utilization management review work focused on Part A, Part B, appeals, and quality-of-care cases for an older adult member population. The role 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. It is a part-time contractor position that is fully remote and requires comfort working with new technologies.
Key Responsibilities
- Conduct clinical reviews for Part A, Part B, appeals, and quality-of-care cases.
- Conduct peer-to-peer discussions as part of utilization management review.
- Participate in acute and post-acute clinical rounds.
- Serve as a clinical resource and subject matter expert for clinical and non-clinical staff.
- Participate in inter-rater reliability activities to support review consistency.
- Use new technologies and adapted workflows to support remote utilization management work.
Required
- MD or DO degree.
- Broad state medical licensure coverage.
- Experience in Medicare utilization management.
- Willingness to obtain additional state licenses as needed.
- Comfort learning and adapting to new technologies.
Preferred
- Experience supporting clinical review, appeals, or quality-of-care determinations.
- Experience working in acute or post-acute care review settings.
Benefits & Perks
- Flexible schedule.
- Fully remote work.