Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States.nReviews appeals for denied services related to current relevant medical experience or knowledge in accordance with appeal policies, if so delegated.nProvides timely peer-to-peer discussions with referring physicians to clarify clinical information and to explain review outcome decisions.nMaintains necessary credentials and immediately informs eviCore of any adverse actions relating to medical licenses and/or board certifications.nParticipates in strategic planning for and evaluation of the Care Managementn nThe successful candidate will be an M.D.
or D.O.
with a current, active, U.S.
state medical license and board certified in Gastroenterology, recognized by the American Board of Medical Specialties (ABMS), with recent practice experience in direct patient care (within the past 18 months).nMust have a minimum of 5 years clinical experience, beyond residency/fellowship nKnowledge of applicable state and federal laws, URAC and NCQA standards a plus, and familiarity with automated processes and computer applications and systems is requiredn nNo nights, no weekends, not call.nPredictable work schedulenFull and part time opportunitiesnSalaried position with benefitsnSupportive organization with collaborative culturen neviCore healthcare is committed to making a positive impact on healthcare, and also making a positive impact on our employees.
eviCore offers a variety of perks and benefits including, but not limited to:nFlexible scheduling and work/life balance with remote and work from home opportunitiesn4 weeks of PTO(starting) per year plus paid holidaysnOne week of CMEnEducation assistance, tuition reimbursement and professional certifications nHealth, dental, vision, and life benefits with employer funded HSAnPaid Volunteer Community Service Days nAmple opportunities for growth, advancement, and promotion n401k retirement plan with company match of 50% employee contributions up to 6% n neviCore is committed to hiring and retaining a diverse workforce.
We are an Equal Opportunity Employer, making decisions without regard to race, color, religion, sex, national origin, age, veteran status, disability, or any other protected class.
Applicants must be able to pass a drug test and background investigation
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