Employer Industry: Healthcare Insurance

Why Consider this Job Opportunity:
- Competitive salary up to 5 years of clinical experience
- Opportunity for career advancement and growth within the organization
- Proficient in Microsoft Office (Outlook, Word, Excel, and PowerPoint)
- Ability to work independently or in a team environment
- Outstanding negotiation, presentation, and facilitation skills
- Knowledge of Medicare programs

What to Expect (Job Responsibilities):
- Develop and administer inter-reviewer reliability methodology for medical necessity determinations
- Analyze and apply clinical metrics to support medical management and quality improvement initiatives
- Direct and support physician review for UM and Appeals reviews
- Lead and serve on various committees to achieve medical utilization, cost, and quality objectives
- Willingness to travel within the State of Tennessee and nationally

What is Required (Qualifications):
- Current MD or DO degree with an unencumbered and unrestricted license to practice medicine in Tennessee
- Board Certification in a recognized specialty by the American Board of Medical Specialties or the American Board of Osteopathic Specialists
- 5 years of clinical experience
- Healthcare administration and/or UM experience preferred
- Ability to interpret and explain complex government policies

How to Stand Out (Preferred Qualifications):
- 0-2 years of experience as an Rx Technician or Customer Service Representative in a healthcare-related service

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