General Practice HMO job located in Florida

• Remote Work
• Competitive Salary
• Great Life / Work Balance

(Login for Information)a large multi-specialty staff model HMO, is seeking a Utilization Management Physician (UMP). This full-time, remote position requires critical thinking skills, effective communication, and decisive judgement. The ideal candidate will have a working knowledge of the responsibilities listed.

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• Render determinations based on relevant clinical information, medical necessity determined by using evidence-based medicine, nationally recognized criteria (i.e. MCG (formally Milliman), InterQual, Centers for Medicare and Medicaid), FHCP Protocols, and the Member’s FHCP Coverage Documents.
• Review clinical criteria and scripts at least annually and update if necessary.
• Assist the CMO in Provider education regarding treatment protocols, treatment options, etc., as appropriate.
• Be available to FHCP UM staff to answer questions regarding cases under review.
• Be available for peer-to-peer discussions of cases under initial or concurrent review either in person, by telephone, or electronically.
• Meet current regulatory standards regarding pre-authorization determinations.
• Be available to discuss urgent cases directly with attending provider.
• For non-certification decisions, specifies the principal reason for the determination not to certify and the clinical rationale for the non-certification.
• Consult with other physicians in medical specialty areas as needed.
• Participate in FHCP committees at the request of the CMO.

Practitioner Requirements Practitioner must meet the following minimum requirements to serve as a Utilization Management Practitioner(“UMP”) for FHCP:

• MD, DO, or PhD degree from an accredited medical school.
• Licensed to practice medicine in the state of Florida without restriction.
• Board certified in primary specialty preferred.
• Have three (3) to five (5) years clinical experience.

• Knowledge and experience with managed care health plan and benefits
• Ability to provide medical knowledge to facilitate resolution of complex issues and required decisions.
• Working knowledge of medical policy and application of criteria
• Agree to participate in the Interrater Reliability Tool or such other audit process employed by FHCP to ensure consistent application of medical policy and coverage criteria.

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• Bonus opportunity
• 401(K) Tax Deferred Plan
• HMO Health Benefits for provider & eligible dependents
• Group Term Life
• Group Disability                  ·  
• Malpractice Insurance
• Paid Leave Time
• CME Stipend
• Licenses, Fees & Dues reimbursed.
• Travel Reimbursement
• Relocation Assistance

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