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Physician Case Reviewer Hematolology Oncology MD in Chicago

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Job Ref:  311352741
Employer:  Network
Company Name:  Julia Edmunds Associates, Inc
Industry:  Healthcare other
Job Type:  Full Time
State:  Illinois
City:  Chicago
Zip Code:  60601

We are currently recruiting an Oncology/ Hematology Physician Case Reviewer. This is a full time opportunity however part- time of 25 hours per week is also available.

Must be available Monday through Friday between the hours of 8AM and 5PM.

Will participate in pre-authorization and quality improvement solutions for oncology and diagnostic imaging solutions.

Will determine the medical necessity of outpatient requests using clinical appropriateness guidelines and health p an medical policy.

*Perform physician-level case review, following initial nurse review, of oncology and high-tech diagnostic imaging requests.
*Determine medical necessity of requests using Clinical Appropriateness Guidelines and client-specific health plan medical policy
*Conduct peer-to-peer consultations with ordering physicians, physician assistants, and advanced practice nurses to provide education regarding established guidelines and accepted standards of care regarding studies and site of service.
*Suggest alternative treatments, studies and sites of care to ordering providers when appropriate
*Provide support and educate clinical and non-clinical staff to foster understanding of the principles associated with appropriate use of covered oncology and diagnostic imaging modalities.
*Actively participate in physician team meetings.
*Demonstrate and maintain knowledge of relevant policies and regulations pertaining to medical oncology and imaging modalities.
*Actively participate in groups that develop, revise and enhance clinical appropriateness guidelines
*Perform first level provider appeals of coverage decisions.

Qualifications:

Must be licensed as a MD or DO
Must be Board Certification in Medical Oncology or Hematology by American Board of Internal Medicine.
Demonstrated knowledge of current practice standards

Attractive salary and benefit package including Medical, Health, Life and Dental insurance, PTO, CME credits, license renewals.etc.

Must live in the Chicago area. Office is located in a beautiful suburb approximately 25 from Chicago. Excellent Schools, Colleges and Universities. A great place to raise a family! Enjoy culture Ballet, Symphony, Philharmonic. Botanical Gardens, Zoo, Concerts, Cultural Arts Center, Museums etc.

Located a short drive to the shores of Lake Michigan. Boating, Sailing, Swimming, Fishing, and all water sports. Walking, jogging and biking trails, golf, tennis, etc.