- Requires M.D. or D.O
- Must possess an active unrestricted medical license to practice
medicine or a health profession.
- Board Certification approved by the American Board of Medical
Specialties required where applicable to duties being performed.
- Internal Medicine, Emergency Medicine, General Surgery certified preferred.
- 10 years of clinical experience or any combination of education
and experience which would provide an equivalent background.
- Utilization Review background a plus.
- Managed care experience, either with a medical group or health
- Knowledge/understanding of determining medical necessity,
utilization review principles, and Continuous Quality Improvement
theory and practice.
- Experience with performance measurements (HEDIS, NQF and other
systems), accreditation standards (NCQA, URAC), member
satisfaction and patient safety preferred.
- Proficiency with the use of a variety of software applications
(e.g., Microsoft Word, Excel, and PowerPoint).
- Ability to travel out of the office to meet with
- Advanced presentations skills with the ability to plan,
facilitate and present at meetings, conferences, etc.
- Requires strong oral, written and interpersonal communication
skills, problem solving skills, facilitation skills.
- Ability to provide excellent customer service/professionalism,
work efficiently, perform multi-tasking, prioritize tasks, and
meet tight deadlines.
- Ability to mentor and develop staff and communicate with other
physicians and team members effectively and respectfully.
- Ability to research, interpret and apply medical scientific
evidence to case reviews and interpret aggregated utilization data
to identify areas of outlier and/or aberrant practices.
- Possess a high degree of integrity and discretion, as well as
the ability to adhere to both company policies and best practices.
- Ensure compliance with security practices and procedures,
including HIPAA and HITRUST standards.
- Ability to efficiently and effectively perform the Key Result
Areas with or without a reasonable accommodation without posing a
direct safety threat to others or self.
- Protect and enhance the Core Purpose and the Core Values of AmeriBen.
AmeriBen is an Equal Opportunity/Affirmative Action Employer
committed to creating an environment of diversity and inclusion
for equal employment and advancement opportunities to all
employees and applicants for employment. All qualified applicants
will receive consideration for employment without regard to race,
religion, color, age, national origin, sex, sexual orientation,
gender identity and/or expression, genetic information,
disability, veteran or military status, or any other category
protected by federal, state and/or local law.
If you are unable to use our online application process due to a
disability, please contact the Human Resources Department