This part time position is responsible for providing guidance of clinical aspects for the prior authorization programs of Telligen and is responsible for the clinical decision making aspects of the prior authorization programs. The incumbent may perform medical necessity reviews, including appeals and peer to peer conference calls.
40% Oversees and is responsible for the medical review activities of the organization or assigned contracts. Conducting critical peer reviews to ensure health given is appropriate and necessary. Instructs other physician reviewers on critical reviews and improvement of health care.
30% Assists Telligen staff with training physician reviewers regarding their responsibilities and functions. Serves as a technical expert on the peer review process.
20% Represents Telligen’s policies and procedures to medical and non-medical persons. Participates in committee meetings representing the Company.
5% Performs miscellaneous duties as assigned.
Current unrestricted clinical license to practice medicine.
Current and active, unrestricted US board certification by the American Board of Medical Specialties or Advisory Board of Osteopathic Medicine.
Post-graduate experience in direct clinical patient care.
3 years experience working with care management programs (health utilization management, case management and/or disease management).
Experience in population health.
Familiar with national coding publications and coding updates.
This position will be between 15-16 hours a week.
10% local and overnight travel.
Telligen and its affiliates are Affirmative Action, E-Verify Participants and Equal Opportunity Employers.
Sensitivity level of information handled in position: medium
Telligen - 15 months ago