Doctor for Utilization Review

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Doctor for Utilization Review

  • Post Date:October 8, 2020
  • Views 259
0 Applications
  • Company AKUA BEHAVIORAL HEALTH PRIVATE LIMITED
    No. of Positions 1
    Sector Private
  • Salary ₹14,000.00 - ₹20,000.00 per year
    Qualification Bachelor's (Preferred)
    Education Graduation
Job Description

Akua Behavioral Health (US COMPANY) is a nationally recognized Mental Health and Substance Abuse treatment program for adults. Accredited by The Joint Commission, Akua meets the highest quality standards for behavioral health and client care.

POSITION: Doctor for Utilization Review

Remote Position: Work from Home at Night

Company: California Healthcare Company

Compensation: 20 Lacs per Year (Base 14 Lacs + Bonus 6 Lacs)

Job Description

  • Evaluate patients’ clinical status using evidence-based criteria to determine medical necessity for detox, residential, PHP, and IOP authorizations.
  • Complete Initial, concurrent, Peer, and retrospective reviews in a timely manner to ensure continuous coverage.
  • Act as a liaison between managed care organizations and the facility’s professional clinical staff.
  • Conduct reviews in accordance with certification requirements of insurance plans or other managed care organizations (MCOs) and document all activities in a detailed manner in applicable CRM/EMR
  • Inform clinical and medical staff of any specific concerns that would extend or restrict patients’ length of stay.
  • Facilitate peer review calls between facility and external organizations.
  • Perform concurrent reviews for patients to ensure that extended stays are medically justified and documented in the patient’s medical records.
  • Act in coordination with the facility or corporate office’s leadership team to improve the quality of services provided within the organization.
  • Initiate and complete the formal appeal process for denied admissions or continued stay.
  • Comply with Akua rules, policies and guidelines consistently
  • Maintain Facility Standards and inform supervisor of any deficiencies
  • Maintain professionalism in interactions with staff and insurance companies at all times and exercise maturity of judgment

Skills/Experience:

  • Must be a Doctor/Dentist (M.D. preferred).
  • Must be able to work Nighttime from Home for a California Healthcare company
  • Must speak Good English
  • Proficient in Excel, Word, and electronic charting
  • Ability to work with minimal supervision

Compensation

20 Lacs per Year (Base 14 Lacs + Bonus 6 Lacs)

Schedule:

  • Night shift

Supplemental Pay:

  • Performance bonus

Experience:

  • Healthcare: 1 year (Required)

Language:

  • English (Required)

Industry:

  • Customer Service

Work Remotely:

  • Yes