Utilization Management Physician Lead

Company: Intermountain Health
Location: Las Vegas
Posted on: October 29, 2024

Job Description:

Job Description: This position interacts with UM physician and operational leadership.

As the UM Physician Reviewer, you are responsible, in partnership with the Sr. Director of UM and the Director of Claims, to conduct peer-to-peer reviews with requesting prior authorization and claims appeal providers. In addition, the role will provide UM related training and education for peer-to-peer reviews, prior authorization reviews, and other education within UM as determined by UM Medical and Operational Leadership. 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.Physical Requirements: Anticipated job posting close date: 05/22/2025 Location: Nevada Central Office Work City: Las Vegas Work State: Nevada Scheduled Weekly Hours: 40 The hourly range for this position is listed below. Actual hourly rate dependent upon experience. $7.25 - $999.99 We care about your well-being - mind, body, and spirit - which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged. Learn more about our comprehensive benefits packages for our Idaho, Nevada, and Utah based caregivers , and for our Colorado, Montana, and Kansas based caregivers ; and our commitment to diversity, equity, and inclusion . Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.
      

Keywords: Intermountain Health, Spring Valley , Utilization Management Physician Lead, Healthcare , Las Vegas, Nevada