REMOTE Physician Reviewer Job at PSG Global Solutions, Chicago, IL

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  • PSG Global Solutions
  • Chicago, IL

Job Description

Description We're looking for a Physician Reviewer M.D. or D.O. , working in Healthcare Systems and Services industry in 300 E. Randolph Street, Chicago, Illinois, 60601, United States . Responsibilities: Evaluates clinical service requests made by an organization's members and providers. Uses clinical judgment in conjunction with organization's criteria to adjudicate these requests. Provides clinical leadership in other areas of the organization. Identifies opportunities to manage members' clinical situations with a view toward creative problem solving and anticipation of possible future clinical problems for the member. Participates in the process to evaluate clinical service requests. Practices anticipatory case management for members whose cases come for review, in partnership with case managers. Participates in the Physician Review Units' appeal process of service denials. Participates in the development of Physician Review Units' policies and procedures. Actively participates in all unit continuous quality improvement activities. #J-18808-Ljbffr PSG Global Solutions

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