Physician Clinical Reviewer, MRx- Oncologist- REMOTE
Company: Prime Therapeutics
Location: Topeka
Posted on: January 21, 2023
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Job Description:
Our work matters. We help people get the medicine they need to
feel better and live well. We do not lose sight of that. It fuels
our passion and drives every decision we make.**Job Posting
Title**Physician Clinical Reviewer, MRx- Oncologist- REMOTE**Job
Description Summary**Key member of the utilization management team,
and provides timely medical review of service requests that do not
initially meet the applicable medical necessity guidelines.
Routinely interacts with physicians, leadership and management
staff, other Physician Clinical Reviewers (PCR), and health plan
members and staff whenever a physician`s input is needed or
required.**Job Description**+ Directs daily involvement in the
following utilization management functions:+ Reviews all cases in
which clinical determinations cannot be made by the Initial
Clinical Reviewer.+ Discusses determinations with requesting
physicians or ordering providers, when available, within the
regulatory time frame of the request by phone or fax.+ Provides
clinical rationale for standard and expedited appeals.+ Provides
assistance and act as a resource to Initial Clinical Reviewers as
needed to discuss cases and problems.+ Utilizes medical/clinical
review guidelines and parameters to assure consistency in the MD
review process so as to reflect appropriate utilization and
compliance with SBU`s policies/procedures, as well as URAC and NCQA
guidelines.+ Ensures documentation of all communications with
medical office staff and/or MD provider is recorded in a timely and
accurate manner.+ Participates in on-going training per inter-rater
reliability process.+ Assists the VP, Medical Affairs in research
activities/questions related to the Utilization Management process,
interpretation, guidelines and/or system support.+ On a requested
basis, reviews appeal cases and/or attends hearings for discussion
of utilization management decisions.+ On a requested basis, may
function as Medical Director for select health plans or regions,
assuming overall accountability for utilization management while
working in conjunction with the VP, Medical Affairs.+ Other duties
as assigned.**Responsibilities**+ Medicare Part D experience
preferred.+ Doctor of Medicine (MD) degree OR Doctor of Osteopathic
Medicine (DO) degree OR Bachelor of Medicine, Bachelor of Surgery
(MBBS) international degree with successful completion of United
States based internship and residency (and successful completion of
United States based fellowship for subspecialists) required.+
Current, unrestricted license to practice medicine or chiropractic
in one or more states of the United States.+ Board Certified by one
of the following: American Board of Medical Specialties (ABMS),
American Board of Osteopathic Specialties (ABOS), American Board of
Internal Medicineor American Board of Osteopathic Internal Medicine
(ABIM/ABOIM).+ Familiarity with the principles and procedures of
utilization management as practiced in managed care organizations,
experience with cost benefit analysis, quality assurance and the
continuous quality improvement process is desirable.**Work
Experience**Work Experience - Required:ClinicalWork Experience -
Preferred:**Education**Education - Required:DO, MBBS, MDEducation -
Preferred:**Certifications**Certifications - Required:DO -
Physician, State Licensure and Board Certified (ABMS or Specialty
Board) - Physician - Physician, MBBS - Bachelor of Medicine,
Bachelor of Surgery - Physician - Physician, MD - Physician, State
Licensure and Board Certified (ABMS or Specialty Board) - Physician
- PhysicianCertifications - Preferred:Potential pay for this
position ranges from $69.91 - $125.83 based on experience and
skills. Pay range may vary by 8% depending on applicant location.To
review our Benefits, Incentives and Additional Compensation, visit
our Benefits Page
(https://www.primetherapeutics.com/careers/benefits/) and click on
the "Benefits at a glance" button for more detail._Prime
Therapeutics LLC is an Equal Opportunity Employer. We encourage
diverse candidates to apply and all qualified applicants will
receive consideration for employment without regard to race, color,
religion, sex (including pregnancy), sexual orientation, gender
identity or expression, genetic information, marital status, family
status, national origin, age, disability, veteran status, or any
other legally protected class under federal, state, or local
law._Prime Therapeutics' fast-paced and dynamic work environment is
ideal for proactively addressing the constant changes in today's
health care industry. Our employees are involved, empowered, and
rewarded for their achievements. We value new ideas and work
collaboratively to provide the highest quality of care and service
to our members.If you are looking to advance your career within a
growing, team-oriented, award-winning company, apply to Prime
Therapeutics today and start making a difference in people's
lives.Prime Therapeutics LLC is an Equal Opportunity Employer. We
encourage diverse candidates to apply and all qualified applicants
will receive consideration for employment without regard to race,
color, religion, sex, sexual orientation, gender identity, national
origin, disability, or veteran status. **?** If you are an
applicant with a disability and need a reasonable accommodation for
any part of the employment process, please contact Human Resources
at 1.866.469.1257 or email Careers@primetherapeutics.com.
Keywords: Prime Therapeutics, Topeka , Physician Clinical Reviewer, MRx- Oncologist- REMOTE, Other , Topeka, Kansas
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