Physician Advisor Case Reviewer OB GYN MD DO - Full-time / Part-time

Physician Advisor  Physician Case Reviewer - OB GYN

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

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

Requirements

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

Must be Board Certified

Must live in the Glendale area. Office is located in a beautiful suburb approximately 10 from Los Angeles 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 25 miles  to the Santa Monica and the beach!  Boating, Sailing, Swimming, Fishing, and all water sports. Walking, jogging and biking trails, golf, tennis, etc.