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Physician Reviewer (PRN - Remote)

Company: Keystone Peer Review Organization, Inc.
Location: Idaho City
Posted on: May 27, 2023

Job Description:

Physician Reviewer (PRN) - Remote

  • Are you an experienced Physician Reviewer looking for a new challenge?
  • Do you value care management and quality improvement?
  • Are you motivated, energetic, and excited to become part of the Kepro team? If so, you might be our next new team member!
    Who we need:
    A Physician Reviewer who will provide principal leadership and clinical expertise to operations relating to the peer review process, utilization review activities, and other activities requiring clinical leadership and consultation. Conducts phone consults with various California psychiatric hospitals to establish medical necessity and continued stay criteria for Medi-Cal beneficiaries.
    Why us?
    Kepro is a rapidly growing national quality improvement and care management organization. We work to ensure that over 20 million people receive the right care, at the right time, in the right setting.
    People Focused. Mission Driven.
    Shape the future of healthcare with us. We are mission driven to improve lives through healthcare quality and clinical expertise.
    We do this through our people.
    At Kepro, you can do meaningful work that makes a real difference for the lives of individuals across the country. We are an organization that cares deeply about our employees, and we provide the training and support to do the best work of your career.
    Benefits are a key component of your rewards package at Kepro. These benefits are designed to provide you and your family additional protection, security, and support for both your career and your life away from work. They are comprehensive and fit a variety of needs and situations. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts and more.
    What you'll do:
    • Conduct peer-to-peer physician consultations as requested/required, documents consultations.
    • Provide clinical expertise with respect to planning and establishing goals and policies to improve clinical operations.
    • Represent the organization through state appeal processes.
    • Review medical information trends, experiences, and approaches, and assists in the development of strategic plans for clinical improvements.
    • Provide program representation at stakeholder engagement meetings.
    • Ensure compliance with regulatory and accreditation requirements.
    • Analyze and remain current on national, state, and local regulations and legislation, which impacts the health care profession.
    • Represent and promote Kepro at seminars, professional societies, medical staff meetings, and other professional settings as appropriate. What you'll need:
      Required Qualifications
      • Licensed Physician (MD/DO) in the state of Idaho.
      • Board Certification required Knowledge, Skills, Abilities
        • Knowledge of Parity in Mental Health and Substance Use Disorder Services Final Rule (Parity Rule; Title 42 of the CFR, part 438.910)
        • Knowledge of Medicaid programs with relevant experience navigating similar complex projects.
        • Knowledge of psychiatric disorders as defined by the most current Diagnostic and Statistical Manual in use in California.
        • Knowledge of standards of practice related to determination of Level of Care.
        • Knowledge of standards of practice related to mental health and other disorders typically requiring psychiatric inpatient.
        • Knowledge and understanding of public sector services and supports.
        • Computer proficiency in Microsoft Excel, Word, PowerPoint, Teams, and Outlook.
        • Ability to determine a clinical diagnosis accounting for psychological and behavioral issues.
        • Ability to utilize computer equipment and web-based software to conduct work.
        • Ability to interact with various office staff as needed to support necessary workflows.
        • Ability to interact with healthcare professionals, patients, their families, and other supports.
        • Ability to communicate effectively to individuals and groups through spoken, written, and electronic media.
        • Ability to attend to detail, effectively prioritize and execute tasks in a timely manner.
        • Assesses and analyzes psychological, emotional, behavioral, and physical functioning.
        • Develops level of care recommendations based upon clinical evaluations. Experience
          • Experience in Utilization Management, Case and Disease Management with knowledge of Medicaid and Medicare programs.
            Thank You!
            We know your time is valuable and we thank you in advance for applying for this position. Due to the high volume of applicants, we receive, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Kepro and invite you to apply to future openings that may be of interest. Best of luck in your search!
            - The Kepro Talent Acquisition Team
            Mental and Physical Requirements
            The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations will be made as required by law in an attempt to enable an individual with a disability to perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to sit for prolonged periods of time; key and/or control objects; interact extensively with internal and external customers; occasionally lift and/or move objects weighing up to 10 pounds; and occasionally travel within the state.
            EOE AA M/F/Vet/Disability
            Kepro is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Keywords: Keystone Peer Review Organization, Inc., Boise , Physician Reviewer (PRN - Remote), Healthcare , Idaho City, Idaho

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