Utilization Management Physician Reviewer

Dane Street, a certified “Great Place to Work” company is seeking a Physician to provide utilization review services for the Group Health Department.

This role requires utilizing clinical expertise to review medical records and provide an interpretation of the medical appropriateness of services in compliance with state regulations, nationally recognized evidence-based guidelines, and client-specific policies. 

Dane Street’s success relies on individual and team contributions every day. We care for our customers, each other, and Dane Street

MAJOR DUTIES & RESPONSIBILITIES

• Review requests for Prior Authorizations and Appeals including medical records and make a medical necessity determination in compliance with state regulations, nationally recognized evidence-based guidelines, and client-specific policies. 
• Ensure clear, concise, and well-supported rationales for determinations.
• Make...