Job Title

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): $99.560 - $128.460 - $143.880 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 applicantu2019s 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