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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