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Blue collar • worcester ma
Physician Reviewer
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Physician Reviewer
Ready to help us transform healthcare? Bring your true colors to blue.
The Role
The Physician Reviewer is responsible for evaluating clinical service requests made by BCBSMA members and providers. The Physician Reviewer uses his / her clinical judgment in conjunction with BCBSMA criteria to adjudicate these requests. At the request of the Associate Medical Director of the Physician Psychologist Review Unit, the Reviewer also provides clinical leadership in other areas of BCBSMA. The Physician Reviewer will look for opportunities to manage members' clinical situations with a view toward creative problem solving and anticipation of possible future clinical problems for the member.
This is a part-time position working roughly 30 hours per week. Additionally, this position is eligible for the Flex persona.
Key Responsibilities :
- Participate in process to evaluate clinical service requests
- Practice anticipatory case management for members whose cases come for review, in partnership with case managers
- Participate in Physician Psychologist Review Units' appeal process of service denials
- Participate in development of Physician Psychologist Review Units' policies and procedures
- Actively participate in all unit continuous quality improvement activities
- Perform additional tasks as assigned by the Associate Medical Director of the Physician Psychologist Review Unit
- Adhere to NCQA, URAC, Medicare and other regulatory standards
Education / Relevant Experience :
Minimum Education Requirements :
High school degree or equivalent required unless otherwise noted above
Location : Boston, Hingham
Time Type : Part time
Salary Range : $236,970.00 - $289,630.00
We offer comprehensive package of benefits including paid time off, medical / dental / vision insurance, 401(k), and a suite of well-being benefits to eligible employees.
WHY Blue Cross Blue Shield of MA?
We understand that the confidence gap and imposter syndrome can prevent amazing candidates coming our way, so please don't hesitate to apply. We'd love to hear from you. You might be just what we need for this role or possibly another one at Blue Cross Blue Shield of MA. The more voices we have represented and amplified in our business, the more we will all thrive, contribute, and be brilliant. We encourage you to bring us your true colors, your perspectives, and your experiences. It's in our differences that we will remain relentless in our pursuit to transform healthcare for ALL.
As an employer, we are committed to investing in your development and providing the necessary resources to enable your success. Learn how we are dedicated to creating an inclusive and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path.