Utilization Management Physician Lead
Company: Intermountain Health
Location: Las Vegas
Posted on: September 27, 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, Las Vegas , Utilization Management Physician Lead, Healthcare , Las Vegas, Nevada
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