Clinical Peer Reviewer Job at Advantage Health Centers, Detroit, MI

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  • Advantage Health Centers
  • Detroit, MI

Job Description

Summary Description

Reviews patient information to ensure treatment/service provided falls within the plan guidelines and that the service was appropriate for the condition. Reviewing for positions – Physicians – (OB/GYN, Internal Medicine, Family Medicine), Physician Assistant, Nurse Practitioner

Specific Responsibilities include, but are not limited to:

  • Reviewing x-rays, patient charts and other patient records to ensure treatment/service provided is within guidelines of the plan.
  • Review pre-authorization paperwork to ensure the intended treatment meets the treatment plan criteria and relevant program criteria.
  • Complete Peer Review Form for each chart reviewed

The list of responsibilities is not intended to be all-inclusive and may be expanded to include other duties that management may deem necessary, if needed.

Academic and Experience Requirements

  • Graduation from an accredited school
  • Valid, unexpired license to practice in Michigan (Physicians)
  • Valid, unexpired certification to practice in Michigan (Physician Assistant, Nurse Practitioner)
  • Successful completion /passing of background check, drug screen and credential check

Other Qualifications Desired:

  • Ability to communicate effectively (verbal and written).
  • Excellent organization and interpersonal skills required.
  • Skilled in working with others in a team environment.
  • Must be proficient in MS Office applications (Word, Excel, PowerPoint)
  • Experience working with EMR systems- eCW preferred. Will train.

Experience

  • Minimum 3-5 years of experience as a Physician, Physician Assistant or Nurse Practitioner
  • Knowledge of medical/clinical procedures, terminology, and codes.

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