Advantage Health Centers

Compensation

Full Description

JOB TITLE : Clinical Peer Reviewer REPORTS TO : President & CEO DEPARTMENT : Peer Review Committee FLSA STATUS : Hourly ? Non Exempt 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.