Utilization Review Physician

Maxim Government Services (MGS), a division of Maxim Staffing Solutions, is currently in search of a Utilization Review Physician for a part time hour, long-term contract assignment at the VA Medical Center in Gainesville, FL.

 

MGS provides healthcare professionals the opportunity to choose from prestigious contracts in some of the top federal and state medical treatment facilities nationwide.  Our dedicated team of professional recruiters and program managers will offer you the same level of care and dedication that you provide your patients.  Apply online today and allow us to match your skills, experience and schedule to find you the employment opportunity you are seeking!

 

Position Duties / Details:

 

Candidate should have 2-5 years experience in utilization review, managed care, healthcare quality assurance, and/or healthcare risk management.  Extensive experience performing retrospective (medical records based) review and concurrent review, including telephonic review via discussion with hospital managed care staff and/or patient’s providers.  Understand concepts of Current Procedural Terminology (CPT) coding and International Classification of Disease—9th Clinical Modification (ICD-9-CM) coding systems.  Be familiar with conventional billing formats for healthcare services (in-patient and out-patient) including prospective payment systems (PPS), Diagnosis Related Groups (DRGs).  Be familiar with industry utilization standards such as InterQual ISD criteria, Milliman and Robertson norms, etc. 

 

Candidate must able to call upon the aforementioned resources and others as necessary to formulate decisions regarding covered days, to determine whether clinical emergency situations actually obtain, and to advise colleagues, including lay claim processing staff on appropriate claims dispositions.  Be able to work in close collaboration with MRT/Coding staff to determine points of patient stabilization (for transfer or discharge) along a healthcare continuum. 

 

Will be an excellent verbal and written communicator, equally at home discussing healthcare coverage issues with providers and vendors or explaining concepts to lay claims staff.  Will be well-informed, pleasant and non-confrontational in dealing with healthcare delivery personnel, co-workers, staff, and medical colleagues. 

 

Will be comfortable interpreting and administering healthcare benefit plans.

 

Minimum Qualifications:

 

12 months of experience

 

Medical School (MD or DO); Internship; ACGME approved Residency Program

 

State Licensure

 

Must be Board Certified or Eligible.

 

For further information and/or to apply to this employment opportunity, please contact Justin Kile at 866-401-5586 x1484 or send email to jukile@maximgov.com .