Jobs in Henderson, NV

About the role

This is a 6-9 Month contract with a possibility of an extension.

What you'll bring

• Utilization management experience supporting Commercial and/or Medicare Advantage populations.
• Minimum of five years of clinical experience, including at least three years in utilization management, physician review, or medical leadership within a managed care or health plan setting.
• An M.D. or D.O. degree with an active, unrestricted medical license in good standing in the state of residence.
• Current board certification in an appropriate medical specialty.
• A minimum of five years of clinical experience, including at least three years in utilization management, physician review, or medical leadership within a managed care or health plan setting.
• Physician-level utilization management experience supporting Commercial and/or Medicare Advantage populations.
• Strong experience conducting inpatient and post-acute case reviews and determining the medical necessity and appropriateness of acute and post-acute services.
• Knowledge of Commercial health plan benefits, coverage guidelines, medical policies, and applicable state and federal requirements.
• Knowledge of Medicare Advantage regulations and CMS coverage criteria.
• Experience applying evidence-based clinical guidelines such as MCG or InterQual.
• Experience conducting peer-to-peer discussions and communicating adverse or complex clinical determinations.
• Strong analytical, clinical documentation, communication, and physician-to-physician negotiation skills.