• Job Description

  Req#: JR216579

  JOB RESPONSIBILITIES

  • Medical Review - Performs medical review activities pertaining to delegated pediatric services including medical review of complex, controversial, or experimental medical services.

  • Quality - Assists Medical Director in improving quality and cost-effectiveness of care and service for members and provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, institutional, and accreditation requirements.

  • Utilization - Identifies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components. Identifies clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice in order to improve the quality and cost of care and interfaces with physicians and other providers in order to facilitate implementation of recommendations. Participates in robust interrater reliability audit process.

  • Education - Assists in the development and implementation of physician education with respect to clinical issues and policies.

  • Medical Leadership - Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities.

  Serves as an expert physician resource and reviewer.

  JOB QUALIFICATIOINS

  • M.D. or D.O.

  • Board certification AND maintenance of certification

  • Must have current, unrestricted license to practice medicine in the state of Ohio

  • Previous experience in clinical medical practice

  • Familiarity with the Ohio Department of Medicaid (ODM) provider agreement requirements and state regulations, including Ohio Revised Code (ORC) and Ohio Administration Code (OAC)

  • Experience with managed care utilization management process and have the ability to communicate with physicians regarding clinical care decision guidelines

  • Current, unrestricted MD or DO Licensure in state(s) of practice

  
  

  Primary Location

  Remote

  
  

  Schedule

  Part time

  
  

  Shift

  Day (United States of America)

  
  

  Department

  Utilization Review

  
  

  Employee Status

  Regular

  
  

  FTE

  0.25

  
  

  Weekly Hours

  10

  About Us

  At Cincinnati Children’s, we come to work with one goal: to make children’s health better. We believe in a holistic team approach, both in caring for patients and their families, and in advancing science and discovery. We strive to do better and find energy and inspiration in our shared purpose. If you want to be the best you can be, you can do it at Cincinnati Children’s.

  Cincinnati Children's is:

  • Recognized by U.S. News & World Report as a top 10 best Children's Hospitals in the nation for more than 15 years

  • Consistently among the top 3 Children's Hospitals for National Institutes of Health (NIH) Funding

  • Recognized as one of America’s Best Large Employers (2025), America’s Best Employers for New Grads (2025)

  • One of the nation's America’s Most Innovative Companies as noted by Fortune

  • Consistently certified as great place to work

  • A Leading Disability Employer as noted by the National Organization on Disability

  • Magnet® designated for the fourth consecutive time by the American Nurses Credentialing Center (ANCC)

  We Embrace Innovation—Together. We believe in empowering our teams with the tools that help us work smarter and care better. That’s why we support the responsible use of artificial intelligence. By encouraging innovation, we’re creating space for new ideas, better outcomes, and a stronger future—for all of us.

  Comprehensive job description provided upon request.

  Cincinnati Children’s is proud to be an Equal Opportunity Employer committed to creating an environment of dignity and respect for all our employees, patients, and families. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, genetic information, national origin, sexual orientation, gender identity, disability or protected veteran status. EEO/Veteran/Disability

• About the company

  502 Cincinnati Children's Hospital Medical Center is an academic pediatric acute care children's hospital located in Cincinnati, Ohio.

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