Job Description:

Job Description: Utilization Review Doctor

As a Utilization Review Doctor, you will be responsible for evaluating the medical necessity and appropriateness of healthcare services provided to patients. Your role will involve reviewing medical records, treatment plans, and documentation to ensure that resources are being used efficiently and effectively.

Responsibilities:

• Conducting reviews of patient medical records and treatment plans
• Evaluating the medical necessity and appropriateness of healthcare services
• Discussing findings with healthcare providers and making recommendations for changes in treatment plans, if necessary
• Ensuring compliance with regulatory requirements and insurance guidelines
• Collaborating with other members of the healthcare team to optimize patient care and resource utilization

Skill Sets:

• Medical degree from an accredited institution
• Board certification in a relevant specialty (e.g. internal medicine, family medicine, etc.)
• Strong analytical and critical thinking skills
• Excellent communication and interpersonal skills
• Ability to work independently and as part of a multidisciplinary team
• Knowledge of healthcare regulations and insurance guidelines

Industry:

Insurance

Category:

Insurance Brokerage

Skills: