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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in medical necessity reviews, prior authorizations, and utilization management within healthcare settings. Possesses strong analytical skills and effective communication abilities to collaborate with healthcare professionals and optimize member outcomes.
Highest-signal resume keywords
Doctor Of Medicine (MD) Or Doctor Of Osteopathic Medicine (DO)Board Certification In PsychiatryUtilization Management ExperiencePeer-To-Peer DiscussionsElectronic Health Records (EHR) Proficiency
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Medical Necessity ReviewsPrior Authorization ReviewsClinical Guidelines DevelopmentQuality Improvement InitiativesAnalytical SkillsCritical Thinking SkillsDocumentation ManagementHealthcare Utilization Management PrinciplesEvidence-Based MedicineRegulatory Compliance
Soft Skills
Excellent Communication SkillsInterpersonal SkillsSelf-MotivatedHighly OrganizedProblem-Solving Skills
Tools & Technologies
Utilization Management SoftwareElectronic Health Records (EHR) Systems
Certifications & Qualifications
Board Certification In PsychiatryActive Medical License
Industry Keywords
Healthcare ServicesClinical PracticeManaged Care OrganizationMedical PoliciesUtilization Management Protocols
About the role
Key responsibilities & impact- Perform comprehensive prospective, concurrent, and retrospective medical necessity reviews for a wide range of healthcare services
- Conduct prior authorization reviews aligned with clinical criteria, regulatory requirements, and contractual agreements
- Lead peer-to-peer discussions with requesting practitioners, provide clinical rationales, facilitate dialogue, and seek alternative solutions
- Issue medical necessity denials when warranted with compliant, well-documented rationales
- Collaborate with Nurse Practitioners, Care Coordinators, and Operations to optimize utilization management and improve member outcomes
- Contribute to developing, reviewing, and revising medical policies, clinical guidelines, and utilization management protocols
- Participate in quality improvement initiatives, audits, and committee meetings
- Maintain detailed documentation of review activities, decisions, and peer-to-peer interactions
- Stay current on medical literature, healthcare trends, regulatory changes, and utilization management best practices
- Champion a member-centric approach while balancing clinical efficacy and cost-effectiveness
- Adapt to the fast-paced, evolving startup environment and proactively solve problems
Requirements
What you’ll need- Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree from an accredited medical school
- Board Certification in Psychiatry
- Active and unrestricted Medical License in at least one state, with the ability to obtain additional state licenses as needed
- Minimum of 5 years of clinical practice experience
- Minimum of 2-3 years of experience in utilization management, medical review, or prior authorizations within an insurance or managed care organization
- Demonstrated success in conducting peer-to-peer discussions with external practitioners
- Excellent communication and interpersonal skills
- Profound understanding of medical necessity criteria, evidence-based medicine, and healthcare utilization management principles
- Strong analytical and critical thinking skills
- Exceptional written and verbal communication skills
- Proficiency with electronic health records (EHR) systems and utilization management software
- Self-motivated and highly organized, with ability to manage a high volume of cases effectively in a remote work environment
- A "roll up your sleeves" attitude and genuine excitement for contributing to a rapidly growing, innovative startup
- No travel required for this position
Benefits
Comp & perks- Curative Health Plan with 100% employer-covered medical premiums for you and 50% coverage for dependents on the base plan
- $0 copays and $0 deductibles with completion of the Baseline Visit
- Preventive and primary care built in
- Mental health support
- One-on-one care navigation
- Chronic condition programs for diabetes, weight, and hypertension
- Maternity and family planning support
- 24/7/365 Curative Telehealth
- Pharmacy benefits
- Comprehensive dental and vision coverage
- Employer-provided life and disability coverage with additional supplemental options
- Flexible spending accounts
- Flexible work options: remote and in-person opportunities
- Generous PTO policy plus 11 paid annual company holidays
- 401K for full-time employees
- Up to 8–12 weeks paid parental leave, based on role eligibility
- Curative will support additional state licensure processes