Radiology Physician Reviewer - Part Time

 

What you will be doing:

The Physician Reviewer is responsible for processing UM requests that do not meet guidelines, processing appeals, and education of the ordering providers in peer-to-peer calls as applicable.

*NM Licensure Required 

Key Responsibilities

• This board-certified Radiologist will be responsible for processing Utilization Management (UM) requests, appeals, and reconsiderations as applicable.

• Required to write a denial rationale in compliance with health plan and government agencies.

• Required to participate in peer-to-peer conversations with requesting providers as needed.

• Required to be compliant with contractual obligations to the health plans, government agencies, and certifications that are maintained by organization.

• Required to apply clinical judgement in consideration of an individual member's clinical needs to render a utilization review determination.

• Required to participate in quarterly UM meetings.

• Responsible for communicating need for additional clinical information to referring/prescribing providers related to consideration for authorization or modification of a referring provider’s request for radiological or diagnostic imaging services.

• Responsible for coordinating with UM team to ensure timely and accurate communication of clinical decisions.

• Required to complete satisfactory quarterly Inter-Rater Exams and biannual audits.

Required Certifications/Licensing

- Valid and unrestricted Medical License in New Mexico

- Board Certified Radiologist

Required Education:

- MD, Graduate of recognized medical degree program

Part Time: This role is designed to provide coverage as needed, which could range from 0 to 40 hours per week dependent on need and scheduling, mutually agreed upon with advanced notice.

​Required Qualifications

Work Experience:

Years of Applicable Experience - 10 or more years

Education:

Professional Medical Degree (Required)

 

Preferred Qualifications

Skills:

• Strong clinical, management and organizational skills.

• Excellent verbal and written communications skills

• Proficient computer skills

Experience:

• Minimum of 10 years of experience in practice in direct patient care after graduating from medical school

 

Additional Job Requirements:

• Remain in a stationary position for prolonged periods of time 

• Be adaptive and change priorities quickly; meet deadlines 

• Attention to detail 

• Operate computer programs and software 

• Ability to communicate effectively with audiences in person and in electronic formats.   

• Day-to-day contact with others (co-workers and/or the public) 

• Making independent decisions 

• Ability to work in a collaborative business environment in close quarters with peers and varying interruptions 

 

Working Conditions: Remote

 

Travel Requirements: No travel required

 

Physical Demands: Sedentary: Exerting up to 10 pounds of force occasionally, and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves remaining stationary most of the time. Jobs are sedentary if movement is required only occasionally, and all other sedentary criteria are met.

 

Premier’s compensation philosophy is to ensure that compensation is reasonable, equitable, and competitive in order to attract and retain talented and highly skilled employees. Premier’s internal salary range for this role is $155,000 - $289,000. Final salary is dependent upon several market factors including, but not limited to, departmental budgets, internal equity, education, unique skills/experience, and geographic location. Premier utilizes a wide-range salary structure to allow base salary flexibility within our ranges.

Employees also receive access to the following benefits:

·       Health, dental, vision, life and disability insurance

·       401k retirement program

·       Paid time off

·       Participation in Premier’s employee incentive plans

·       Tuition reimbursement and professional development opportunities

Premier at a glance:

• Ranked #1 on Charlotte’s Healthiest Employers list for 2019, 2020 and 2022, and 49th Healthiest Employer in America (2022)
• ​Named one of the World’s Most Ethical Companies® by Ethisphere® Institute for the 13th year in a row
• The only company to be recognized by KLAS twice for Overall Healthcare Management Consulting
   

Employees receive:

• Perks and discounts
• Access to on-site and online exercise classes
• Paid time off to volunteer in their communities

Premier is looking for smart, agile individuals like you to help us transform the healthcare industry. Here you will find critical thinkers who have the freedom to make an impact. Colleagues who share your thirst to learn more and do things better. Teammates committed to improving the health of a nation. See why incredible challenges require incredible people.

Premier is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to unlawful discrimination because of their age, race, color, religion, national origin, ancestry, citizenship status, sex, sexual orientation, gender identity, gender expression, marital status, familial status, pregnancy status, genetic information, status as a victim of domestic violence, covered military or protected veteran status (e.g., status as a Vietnam Era veteran, disabled veteran, special disabled veteran, Armed Forces Serviced Medal veteran, recently separated veteran, or other protected veteran) disability, or any other applicable federal, state or local protected class, trait or status or that of persons with whom an applicant associates. We also consider qualified applicants with criminal histories, consistent with applicable federal, state and local law. In addition, as a federal contractor, Premier complies with government regulations, including affirmative action responsibilities, where they apply.

Premier also provides reasonable accommodations to qualified individuals with a disability or those who have a sincerely held religious belief. If you need assistance in the application process, please reply to [email protected] or contact Premier Recruiting at 704.816.5200.

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