"Alerted.org

**Facility:** Health Plan

**City** San Diego

Department

Job Status

Per Diem

Shift

Day

FTE

0

Shift Start Time

Shift End Time

California Physicians and Surgeons License - Medical Board of CA; Doctor of Osteopathic Medicine (DO); Doctor of Medicine (MD)

Hours** **:

Shift Start Time:

Not Specified

Shift End Time:

Not Specified

AWS Hours Requirement:

8/40 - 8 Hour Shift

Additional Shift Information:

Weekend Requirements:

No Weekends

On-Call Required:

No

Hourly Pay Range (Minimum - Midpoint - Maximum):

$96.430 - $124.420 - $152.420

The stated pay scale reflects the range that Sharp reasonably expects to pay for this position.  The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant’s years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices.

**Please Note:** As part of our recruitment process, you may receive communication from Dawn, our virtual recruiting assistant. Dawn helps coordinate scheduling for screening calls and interviews to ensure a smooth and timely experience. Rest assured, all candidate evaluations and hiring decisions are made by our recruitment and hiring teams.

What You Will Do

The position is responsible for the medical direction of Authorization Review for Sharp Health Plan (SHP). The Physician Reviewer will perform all reasonably necessary functions to ensure quality of care and appropriate utilization in the most cost-effective, appropriate and professional manner, which meets the expressed needs of patients and professional colleagues.

Required Qualifications

+ Doctor of Medicine (MD) or

+ Doctor of Osteopathic Medicine (DO)

+ 5 years' experience as a practicing primary care physician with knowledge of managed care and the process for prior authorization review.

+ California Physicians and Surgeons License - Medical Board of CA - REQUIRED

Other Qualification Requirements

+ Board Certification in Internal Medicine or Family Medicine preferred.

Essential Functions

+ Customer serviceProvides prompt, accurate, and excellent services to internal and external customers.Develops solid professional working relationships with various internal departments and units and, as required, vendors and providers.

+ General supportParticipates in special projects and other duties as assigned. These may include, but are not limited to, work groups, audits and back-up medical management support for the Chief Medical Officer.

+ Professional competencyMaintain current knowledge of the service denial process and pertinent health plan authorization criteria and regulations.Keeps abreast of advances in medical care methodologies that may contribute to enhanced quality of services and effective utilization of services.

+ Provider interactionPeriodically presents information regarding authorization services at various SHP meetings on an as needed basis.Provides educational support for PCPs both on a "program" basis and one-on-one basis as needed in regard to proper utilization authorization.Provides strong leadership and direction for appropriate and efficient prior authorization services.

+ TrainingParticipate in Milliman and Hayes Technology Assessments training or have plans to do so (whether independently or through SHP).

Knowledge, Skills, and Abilities

+ Knowledge of physician social and political behavior and managed care philosophy.

+ Demonstrate effective communication skills, ability to work collaboratively with medical leadership and administration of SHP, medical staff, nurses, and Sharp Hospital administration.

+ Position is expected to be on-call based on hours that are mutually agreed upon.

Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class