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Physician Advisor Case Reviewer Primary Care MD DO in Chicago

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Job Ref:  311351777
Employer:  Network
Company Name:  Julia Edmunds Associates, Inc
Industry:  Healthcare other
Job Type:  Full Time
State:  Illinois
City:  Chicago
Zip Code:  60601

Physician Advisor Physician Case Reviewer - Primary Care Internal Medicine Family Practice

Salary $195,000 Plus 7% Bonus!

Full-time preferred. Part - time possibility of 30 hours per week.

Mon-Friday 8AM-5PM No nights, Holidays or weekends!!!!

Will work in the office for 10-12 months. Then there is an opportunity to work from a home based office.

Will determine the medical necessity of outpatient requests using clinical guidelines and health plan medical policy.

Will review pre- authorization of high tech diagnostic imaging, cardiac testing, speciality pharmacy and sleep management testing.

Conduct peer-to-peer discussions with physicians and mid- level practitioners to provide education regarding established guidelines and accepted
standards of care as pertaining to the use of diagnostic imaging studies, cardiac testing, specialty pharmacy and sleep management testing.

Document the pre-certification review in the pre-certification computer application.

Perform first level provider appeals as designated b the client for adverse determinations.

Participate in periodic physician reviewer meetings.

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

7% bonus


Must have an unrestricted license as a Doctor of Medicine or Doctor of Osteopathic Medicine

Must be Board Certified

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.