Physician Reviewer

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🔥 1 minute ago

🏄 California – Remote

🏄 California – Remote

💵 $248.9k - $311.2k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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AltaMed Health Services

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

🤝 Non-profit

🧘 Wellness

💰 Grant on 2024-03

Healthcare • Non-profit • Wellness

AltaMed Health Services is one of the nation’s largest community health networks, providing care to patients in the diverse neighborhoods of Los Angeles and Orange counties for over 45 years. As a non-profit organization, AltaMed is dedicated to community health, focusing on the well-being of patients and the broader community. They operate 46 locations offering primary medical, dental, and senior care, and are recognized for their high patient satisfaction and quality care standards. AltaMed is also a leader in enrolling individuals in healthcare programs, committed to ensuring that quality health care is a fundamental right for everyone.

📋 Description

• Conduct routine reviews of authorization requests across all lines of business using applicable national/state health plans and recognized guidelines • Approve authorizations according to delegation responsibilities, the AltaMed Authorization Matrix, training, and licensing restrictions • Process authorization denials using standard denial language and post recommendations in the authorization platform • Review and make recommendations on retro claims for outpatient authorizations, inpatient authorizations, and emergency room claims • Participate in ad hoc projects and analyze high-cost utilization, unmanaged care, inappropriate utilization, billing practices, and budgeting/financial reporting • Identify high-risk populations and refer patients to appropriate case management programs • Provide oversight, guidance, and training to UM nurse reviewers and other UM staff when applicable • Provide case management to hospitalized patients and patients needing ambulatory case management • Participate in interdisciplinary care coordination with social work, mental health counseling, psychosocial support, in-home support, legal services, skilled nursing, and home health teams

🎯 Requirements

• MD/DO • Physician Training Program completed • Graduation from an accredited medical training program • Valid BLS certification or higher, following American Heart Association (AHA) or American Red Cross guidelines • Board Certified preferred

🏖️ Benefits

• Medical, Dental and Vision insurance • 403(b) Retirement savings plans with employer matching contributions • Flexible Spending Accounts • Commuter Flexible Spending • Career Advancement & Development opportunities • Paid Time Off & Holidays • Paid CME Days • Malpractice insurance and tail coverage • Tuition Reimbursement Program • Corporate Employee Discounts • Employee Referral Bonus Program • Pet Care Insurance • Discretionary bonuses or incentives may apply

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