Please mention DailyRemote when applying
See how much of this job your resume covers, and what’s missing.
Want a recruiter to go through it line by line?
Get professional reviewUpload your resume and we draft a letter for this exact role, tailored to what it asks for.
Provides clinical expertise and guidance for medical necessity appeals and utilization reviews. Acts as a physician resource for regulatory and revenue cycle denial processes.
Provides clinical expertise and guidance to Clinical Analysis and appeals team. Acts as the physician advisor for medical necessity appeals and for the Pennsylvania Medical assistance (PAMA) utilization reviews. Acts as a physician resource for the regulatory and revenue cycle denial and appeals processes for hospital activity, including utilization review for all PAMA cases, all UM denials and appeals.
Experience
General Experience and strong working knowledge of the Interqual Criteria Set and
hospital reimbursement systems Required
General Experience in a role dealing with Second and Third level appeals processes
including direct experience with being an expert witness Required
General Experience in a managed care environment Required
General Experience in an Administrative Leadership role Preferred
Licenses
PA Medical Physician License Required or
PA Osteopathic Physician Required
Stop the endless job search. Our AI finds and applies to the best jobs for you.
Featuring 216,485+ Jobs in Healthcare
Answer easy questions
216,485+ jobs across 15+ categories
Get your best job matches
Only hand-screened, legit jobs
Find a remote job faster
No ads, scams, or junk
“I was the first applicant for a remote marketing position that got listed on the company website the same day I applied. Had an interview within 48 hours!”
— Sarah J.
·
Marketing Manager
★★★★★
Verified
