5 jobs found

Key member of the utilization management team, and provides timely medical review of service requests that do not initially meet the applicable medical necessity guidelines. Routinely interacts with physicians, leadership and management staff, other Physician Clinical Reviewers (PCR), and health plan members and staff whenever a physician`s input is needed or required. Directs daily involvement in the following utilization management functions: Reviews all cases in which clinical determinations cannot be made by the Initial Clinical Reviewer. Discusses determinations with requesting physicians or ordering providers, when available, within the regulatory time frame of the request by phone or fax. Provides clinical rationale for standard and expedited appeals. Provides assistance and act as a resource to Initial Clinical Reviewers as needed to discuss cases and problems. Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD...

PlushCare, an Accolade company (NASDQ: ACCD), is a Silicon Valley-based virtual primary care platform that is transforming the healthcare industry by making exceptional healthcare more accessible, convenient, and affordable. Since 2015, we've connected hundreds of thousands of patients throughout the United States with world-class physicians from a phone or laptop. As we continue to grow and expand our services, we are looking for passionate and empathetic individuals to be part of our journey. Experience in the startup ecosystem is helpful, but a growth mindset and passion for helping people live healthier, happier & longer lives is essential.  The details: We are seeking elite physicians who are board-certified in Internal Medicine or Family Medicine to practice on the PlushCare platform. Our patient-base is a diverse population with a mix of private, public, and uninsured patients. Our typical clinical scope includes urgent & primary care.  We...

Lina is a mental health practice that aims to be a leader in affordable psychiatric telemedicine. We are hiring Psychiatric-Mental Health Nurse Practitioners (PMHNPs) to provide initial consultations and follow-up medication management. The compensation for the role is $120,000 to $160,000 per year. You will see patients seeking online outpatient diagnosis and treatment for conditions such as depression and anxiety. We will find patients, schedule appointments and handle other administrative tasks for you. The majority of your time will be dedicated directly to patient care. This role offers the freedom of private practice without the administrative hassle. You will practice 100% remotely from home and work within your preferred schedule. No on-call or holiday work is required. We believe patients deserve access to mental healthcare without an excessive wait. Our expert clinicians and easy-to-use technology enhance the patient experience. Join our team of passionate,...

Plume is a passion-fueled, mission-driven company that is trans-founded and focused on radically increasing access to healthcare for the trans community, supporting a bold, authentic and healthy lifestyle. We hope to make gender-affirming hormone therapy easily accessible at the touch of a button in every state of the U.S.   We are rapidly expanding and are now available to more than 1 million trans individuals and have built a more than 50% trans team. We are an organization by and for trans folks and we want heart-forward awesomely talented teammates to join us on our journey.   We are currently hiring Physicians, Nurse Practitioners, and Physician Assistants- we welcome all state licenses but specifically are in need of folks with  Texas, California, Florida, Pennsylvania, Georgia, Arizona, Colorado, New York, Missouri, Michigan, Tennessee, Virginia, New Jersey, Alabama, Louisiana, Maine, and Massachusetts licenses at the moment .  ...

Looking for an intellectually stimulating role that will challenge you to use your current knowledge and build new skills? Join us as an Associate Medical Director at eviCore, where you’ll be empowered to make a difference in the lives of patients by improving the quality of healthcare nationwide.     What you’ll do:   Use your analytical mindset.  Provide timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria. Review appeals for denied services related to relevant medical experience and our evidence based guidelines, in accordance with appeal policies, if so delegated.  Be a team player.  Work collaboratively with over 400 eviCore Physician Peers to help ensure patients receive proper care via evidence based decision making.  Provide timely peer-to-peer...