Utilization Reviewer - Doctor

Job Description:

The Reviewer is responsible for assessing the delivery of medical services to determine if the care provided is appropriate, medically necessary, and of high quality. This includes examination of documents to see if patients are given care consistent with their needs as well as inputting of approved Guidelines and References. The review typically involves medical records abstracting, analysis and documentation based on client-specific guidelines and templates.

Qualifications

• Strong clinical knowledge and experience in reviewing diagnostic and treatment plans
• Familiarity with utilization review procedures, medical coding, and regulatory compliance
• Analytical and critical thinking skills with an ability to evaluate medical records effectively
• Proficient in maintaining accurate reports and detailed documentation
• Strong communication and collaboration skills to interact with healthcare providers and team members
• MD or relevant medical degree, licensed physician strongly preferred
• Experience in utilization review, case management, or a similar field is a significant advantage

Pay:25,000.00-30,000.00 per month