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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates extensive clinical knowledge and experience in evaluating authorization requests and documentation across multiple specialties, while effectively engaging with medical directors and physicians to ensure compliance with evidence-based criteria.
Highest-signal resume keywords
Active MD Or DO Medical Licensure3+ Years Clinical Experience Post-ResidencyClinical Knowledge Across Multiple AreasAbility To Work IndependentlyProficiency In Basic Computer Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Soft Skills
High Level Of PerformanceAbility To Meet Quality And Productivity Standards
Certifications & Qualifications
Active MD Or DO Medical Licensure
Industry Keywords
Authorization DenialsDocumentation SupportEvidence-Based CriteriaUtilization ReviewCase ManagementPeer-To-Peer CasesClinical EvaluationsClient FacilitiesAttending PhysiciansMedical Directors
About the role
Key responsibilities & impact- Review payor peer-to-peer cases for authorization denials
- Evaluate whether proper documentation supports the requested admission status, procedure, and care setting
- Advise client facilities regarding appropriateness of requests based on available documentation
- Discuss cases with medical directors from the payor side
- Address authorization requests, documentation support, evidence-based criteria, and complex clinical evaluations
- Engage with attending physicians to discuss appropriate status supported by documentation
- Contact utilization review teams and/or case managers at client hospitals regarding case determinations
- Provide written case analyses and conduct reviews across multiple specialties
Requirements
What you’ll need- Active, unrestricted MD or DO medical licensure
- Minimum 3+ years of clinical experience post-residency completion
- Strong clinical knowledge across multiple clinical areas
- Ability to work independently with a high level of performance in a rapidly changing, fast-paced environment
- Proficiency in basic computer skills
- Ability to work during pre-scheduled hours
- Ability to meet quality and productivity standards
Benefits
Comp & perks- Eligible to participate in annual bonus plan at a target of 10.00%
- Competitive benefits package
- Opportunity to constantly learn, collaborate across groups and explore new career paths
- Opportunity to contribute, think boldly and create meaningful work
- Reasonable accommodation support for applicants with disabilities