About the role
The team manages utilization review processes for health services. The physician advisor conducts discussions with treating providers to review medical necessity and determine appropriate care levels. This involves applying clinical criteria and Medicare regulations to authorization requests.
Our summary of the posting; the original is on the Clover Health careers page.
What the posting requires
- Required
- MD
- Medical license
- DO
- Preferred
- Clinical documentation
- Clinical criteria
- Medical necessity
- Policy application
- Contractual issues
Preferred experience: 5+ yrs
These tags are our reading of the posting. They can miss something; the original posting is the reference.