Keystone Peer Review Organization, Inc. Looking for Oral Surgeon (PRN Remote Peer Reviewer) at Jackson, Wyoming Full Time

Oral Surgeon (PRN Remote)

• Are you an experienced Oral Surgeon looking for a new challenge?
• Do you value care management and quality improvement?
• Are you motivated, energetic, and excited to become part of the Kepro team?

If so, you might be our next new team member!

Who we need:

Kepro is looking for an Oral Surgeon who can provide medical necessity review to support the completion of oral surgery review types associated with the pre-certification process. Also responsible for serving as a consultant on clinically related topics such as (but not limited to) quality of care concerns, evidenced based practice questions, or developing medical necessity criteria. This is a consultant position on an as needed basis. While Kepro cannot guarantee any pre-established volume commitments, your approval as a credentialed peer reviewer will present you with opportunities to work with our organization in both the private and public sector.

Why us?

Kepro is a rapidly growing national quality improvement and care management organization. We work to ensure that over 20 million people receive the right care, at the right time, in the right setting.

People Focused. Mission Driven.

Shape the future of healthcare with us. We are mission driven to improve lives through healthcare quality and clinical expertise.

We do this through our people.

At Kepro, you can do meaningful work that makes a real difference for the lives of individuals across the country. We are an organization that cares deeply about our employees and we provide the training and support to do the best work of your career.

Benefits are a key component of your rewards package at Kepro. These benefits are designed to provide you and your family additional protection, security, and support for both your career and your life away from work. They are comprehensive and fit a variety of needs and situations. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts and more.

What you’ll do:

• Responsible for Oral Surgery Utilization Management medical necessity reviews and determinations utilizing electronic .
• Serve as a consultant for clinical topics such as quality of care concerns, evidenced based medical practice, or industry standard processes.
• Draft medical necessity review criteria in the event a service is not covered under nationally recognized medical necessity review criteria.
• Serve as a clinical consultant.
• Available to clinical reviewers for individual consultation on a case-by-case basis.

What you’ll need:

Required Qualifications

Oral Surgeon peer reviewers must meet the following qualifications:

• Shall have a minimum of five (5) years active practice experience, providing direct clinical care to patients as recent as within the past three (3) years
• Doctor’s of Medicine, Osteopathic Medicine, Dentistry, Podiatry, or other Allied Health Care Practitioners
• Holds an active, unrestricted license or certification to practice medicine or a health profession in a state or territory of the United States
• Must be Board Certified in a specialty recognized by the American Board of Medical Specialties, the Advisory Board of Osteopathic Specialists, the American Dental Association (ADA), the American Board of General Dentistry (ABGD), the American Board of Podiatric Surgery(ABPS), or the American Board of Podiatric Medicine (ABPM)
• Must be located within the United States or one of its territories when conducting an internal appeal or external review

Knowledge, Skills, Abilities

• Understanding of medical necessity review process, required
• Understanding of clinical criteria, desirable
• Basic proficiency in working with web-based care management platforms and Microsoft Office

Experience

• 5+ years of clinical practice
• At least 1 year experience in completing medical necessity reviews
• Prior health plan or hospital experience in utilization review is desirable

Thank You!

We know your time is valuable and we thank you in advance for applying for this position. Due to the high volume of applicants we receive, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Kepro and invite you to apply to future openings that may be of interest. Best of luck in your search!

~ The Kepro Talent Acquisition Team

Mental and Physical Requirements

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations will be made as required by law in an attempt to enable an individual with a disability to perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to sit for prolonged periods of time; key and/or control objects; interact extensively with internal and external customers; occasionally lift and/or move objects weighing up to 10 pounds; and occasionally travel within the state.

EOE AA M/F/Vet/Disability

Kepro is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.