Successful candidates will:
Perform physician-level case review, following initial nurse review, of high-tech diagnostic imaging and sleep management studies. Determine medical necessity of requests using AIM Clinical Appropriateness Guidelines and client-specific health plan medical policyConduct peer-to-peer consultations with ordering physicians, physician assistants, and advanced practice nurses to provide education regarding established guidelines and accepted standards of care regarding studies and site of service.Suggest alternative studies and sites of care to ordering providers when appropriateProvide support and educate clinical and non-clinical staff to foster understanding of the principles associated with appropriate use of covered modalities.Actively participate in physician team meetings.Demonstrate and maintain knowledge of relevant policies and regulations pertaining to sleep management, and imaging modalities.Actively participate in groups that develop, revise and enhance clinical appropriateness guidelinesPerform first level provider appeals of coverage decisions.Obtain additional state licensure based upon state regulations and health plan needs
Qualifications
Qualified Candidates will have:
Current unrestricted medical license(s) as a Doctor of Medicine or Doctor of Osteopathic Medicine in an appropriate state.Board Certification in Cardiovascular Disease or Interventional Cardiology by the American Board of Internal Medicine.Demonstrated knowledge of current practice standards in specialtyStrong oral communication and interpersonal skillsComputer literacy with the ability to learn new applicationsAbility to multi-taskAbility to work both independently and in a team environmentAbility to work in a dynamic, fast-paced environment
Perform physician-level case review, following initial nurse review, of high-tech diagnostic imaging and sleep management studies. Determine medical necessity of requests using AIM Clinical Appropriateness Guidelines and client-specific health plan medical policyConduct peer-to-peer consultations with ordering physicians, physician assistants, and advanced practice nurses to provide education regarding established guidelines and accepted standards of care regarding studies and site of service.Suggest alternative studies and sites of care to ordering providers when appropriateProvide support and educate clinical and non-clinical staff to foster understanding of the principles associated with appropriate use of covered modalities.Actively participate in physician team meetings.Demonstrate and maintain knowledge of relevant policies and regulations pertaining to sleep management, and imaging modalities.Actively participate in groups that develop, revise and enhance clinical appropriateness guidelinesPerform first level provider appeals of coverage decisions.Obtain additional state licensure based upon state regulations and health plan needs
Qualifications
Qualified Candidates will have:
Current unrestricted medical license(s) as a Doctor of Medicine or Doctor of Osteopathic Medicine in an appropriate state.Board Certification in Cardiovascular Disease or Interventional Cardiology by the American Board of Internal Medicine.Demonstrated knowledge of current practice standards in specialtyStrong oral communication and interpersonal skillsComputer literacy with the ability to learn new applicationsAbility to multi-taskAbility to work both independently and in a team environmentAbility to work in a dynamic, fast-paced environment