Base: $90.87 - $154.33 ph; bonus/equity: not speci...
Fully remote
5+ years clinical experience in gastroenterology
Md, do, or mbbs degree required
Ability to communicate with physicians via phone/fax
This role serves as a key member of the utilization management team providing timely medical reviews for service requests that do not meet initial guidelines
Job Summary
This role serves as a key member of the utilization management team providing timely medical reviews for service requests that do not meet initial guidelines.
The position requires discussing determinations with requesting physicians and providing clinical rationale for standard and expedited appeals within regulatory timeframes.
Prime Therapeutics offers a competitive salary range of $90.87 - $154.33 per hour along with comprehensive benefits and incentives.
Matching Summary
This role serves as a key member of the utilization management team providing timely medical reviews for service requests that do not meet initial guidelines.
Salary
Base: $90.87 - $154.33 per hour; Bonus/Equity: Not specified; Benefits: Comprehensive benefits and incentives available
Skills & Requirements
Must-have
5+ years clinical experience in Gastroenterology
MD, DO, or MBBS degree required
Ability to communicate with physicians via phone/fax
Knowledge of URAC and NCQA guidelines
Accurate documentation of medical communications
Nice-to-have
Experience with inter-rater reliability training
Willingness to assist Medical Director with research
Purpose-driven career mindset
Ability to attend hearings on requested basis
Key Requirements
DO, MBBS, or MD degree
Minimum 5 years of clinical experience
Must be eligible to work in the US without visa sponsorship
Eligibility to work in United States
Work Rights
Must be eligible to work in the United States without need for work visa or residency sponsorship