MD or DO degree
5+ years of direct clinical patient care experience post residency or fellowship. This experience includes time in an inpatient and or outpatient environment and care of a Medicare type population, such as the disabled or those over 65 years of age.
Current and ongoing Board Certification an approved ABMS or AOA Medical Specialty
A current and unrestricted license in at least one jurisdiction
Are willing to obtain additional licenses
No current sanction from Federal or State Governmental organizations
Able to pass credentialing requirements
Prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and home health or post-acute services such as inpatient rehabilitation.
Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and Commercial products, or other medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management.
Utilization management experience in a medical management review organization, such as Medicare Advantage, Managed Medicaid, or Commercial health insurance.
Experience with national guidelines such as MCG or InterQual
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.