Physician, PMR, Orthopedics, Neurology, Outpatient Prior Authorizations

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🕒 June 29

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Virtix Health

WebsiteLinkedInAll Job Openings

11 - 50 employees

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance • Technology

Virtix Health is a company that partners with health plans across the country to enhance clinical, financial, and operational outcomes. They offer a variety of services, including virtual wellness visits, in-home health risk assessments, retrospective chart review, workflow technology, and patient engagement services. They specialize in risk adjustment coding and clinical data connectivity, providing technology solutions that automate data acquisition and improve the management of medical records. Their aim is to innovate how healthcare data is exchanged to elevate the performance of health plans of all sizes.

📋 Description

• Conduct Prior Authorizations for High Risk procedures performed on patients of advanced age • Conduct regular reviews to monitor the appropriateness of care provided to beneficiaries and recommend any necessary interventions or adjustments need to align with CMS National and Local Coverage Determinations (NCD/LCD) • Assist in the training and development of clinical teams on CMS NCD/LCD guidelines, clinical documentation and compliance • Provide recommendations for improvements in clinical practices based on findings from record reviews, data analysis, and best practices in the field • Participate in the development and implementation of quality improvement initiatives to enhance care delivery and achieve CMS performance goals • Maintain accurate and up to date records of all clinical reviews, audits and quality improvement efforts

🎯 Requirements

• Be a board-certified clinician, including a Doctor of Medicine or a Doctor of Osteopathy identified by an individual NPI in a specialty recognized by the American Board of Medical Specialties • Board certified for at least 3 years • Currently hold an active, valid and unrestricted license to practice medicine in at least one U.S. state or the District of Columbia • Must not be excluded from participating in Medicare, Medicaid or the Children’s Health Insurance Program • State of Washington license to practice medicine preferred or willingness to obtain • Be associated with a primary specialty designation that aligns with PMR, neurology, pulmonology, urology, or orthopedics • Utilization management experience preferred.

🏖️ Benefits

• Comprehensive training and education program • Quality of life with a remote predictable, full-time schedule • Opportunities for career growth within the organization