Evaluates clinical service requests made by an organization's members and providers. Uses clinical judgment in conjunction with organization's Utilization Management criteria to adjudicate these requests. Performs peer to peer discussions. Actively participates in all unit continuous quality improvement activities. Other duties as assigned by the Medical Director. Board Certified (ABMS) M.D. or D.O, unrestricted and active license to practice medicine requested and 5 years clinical experience to include inpatient experience, or any combination of education/experience that would provide an equivalent background. Must have understanding of managed care and demonstrate PC proficiency, as file review will be done via computer in most cases. (Note: Position does not provide direct patient care or medical diagnosis.)Note :We are looking for 40hrs per week aggregate from the two positions. If we find a strong candidate that is available to work 40hrs per week consistently, we can do away with one position.VIVA is an equal opportunity employer. All qualified applicants have an equal opportunity for placement, and all employees have an equal opportunity to develop on the job. This means that VIVA will not discriminate against any employee or qualified applicant on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.
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