Serve as the Physician Clinical Reviewer for Interventional Pain Management, reviewing cases that do not initially meet the applicable medical necessity guidelines
Discusses determinations (peer to peer phone calls) with requesting physicians or ordering providers
Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process
Provides clinical rationale for standard and expedited appeals
Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner
Participates in on-going training per inter-rater reliability process
May function as Medical Director for selecting health plans or regions, assuming overall accountability for utilization management

MD/DO/MBBS
Required
Minimum of five (5) years’ experience in the practice of Pain Medicine, post-residency
Preferred
Current, unrestricted clinical license in medicine or required specialty
Required
Active Board Certification in Pain Management or Active Board Certification in another specialty and clinical experience in Interventional Pain Management
Required
Strong clinical, management, communication, and organizational skills
Required
Energetic and curious with a passion for quality and value in health care
Required
Computer Proficiency
Required

Field Medical Director, Pain Management

Key skills