Sleep Medicine - Utilization Management Medical Reviewer (Remote - Part Time)

As a Utilization Management Medical Reviewer for our asleep program you will conduct utilization reviews for medical necessity determinations. As appropriate and when required, this position interfaces with the internal staff, Providers, and ordering physicians. 

In this role, you will:

• Conduct medical necessity review on cases that may not meet criteria, and issues adverse determinations as needed.
• Achieves Service Level Agreement (SLA) metrics and performance guarantees as required by health plan clients
• Ability to work up to 15 hours a week (including weekends/holidays)
• Other duties as appropriate

• MD or DO with an active and unencumbered medical licenses 
• current and unexpired specialty board certifications- internal medicine with certification in sleep medicine, pulmonology or somnologist
• 3-5 years experience in clinical practice
• 3-5 years experience doing utilization review 
• Prior experience utilizing evidence-based clinical guidelines (e.g., Milliman/Interqual) is preferred.

#IDCC

We are an equal opportunity employer. Employment selection and related decisions are made without regard to age, race, color, national origin, religion, sex, disability, sexual orientation, gender identification, or being a qualified disabled veteran or qualified veteran of the Vietnam era or any other category protected by Federal or State law.

CareCentrix accepts applications on an ongoing basis until a candidate is identified.