This is a temporary position, scheduled to go through the end of July.

Essential Job Functions
 Assists in development and maintaining an efficient UM program to meet the needs of the health plan members and commensurate with company values.
 Educates primary care physicians regarding systems, structures, processes and outcomes necessary for assurance of regulatory compliance related to market activities.
 Develops strategies for improving all aspects of market performance including RAPS,
membership, and medical management.
 Participates in case review and medical necessity determination.
 Conducts post service reviews issued for medical necessity and benefits determination
coding.
 Analyzes aggregate data and reports to primary care physician.
 Serves as the liaison between physicians and health plan Medical Directors.
 Supervises the functions of Care Coordination.
 Assesses the effectiveness of the specialty network to ensure members have access to multi-specialties within their demographic area.
 Represents the providers as an influence to the credentialing committee.
 Reviews policies and procedures of credentialing department and offers guidance for revision and implementation of process.
 Educates primary care network and assists in problem resolution.
 Assists in development of medical management protocols.
 Performs analysis of utilization data and suggests/implements corrective action plans with network physicians.
 Performs all other related duties as assigned.
Customer Service

Minimum Required Education, Experience & Skills
 Doctor of Medicine (M.D.) or Doctor of Osteopathy (D.O.) degree required.
 Board Certified Family Practitioner or Internal Medical Specialist required.
 Unrestricted licensed in Texas, Florida, Georgia, or New Jersey required.
 Five or more years of clinical practice experience required.
 Two or more years of experience in utilization management activities required.
 Proficiency with Microsoft Office applications required.

Hours are 8am-5pm central, Mon-Fri with some weekends

#INDMLK

Job Type: Temporary

Pay: $120.00 per hour

Benefits:

• Dental insurance
• Health insurance
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Work Location: Remote