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Baylor Scott & White Health

Irving, Texas

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AdventHealth

Manchester, Kentucky

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South Texas Health System

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Optum

Springfield, Massachusetts

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Gainesville, Georgia

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St. Luke's Health System

Twin Falls, Idaho

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St. Luke's Health System

Twin Falls, Idaho

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Duke University Health System

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Baylor Scott & White Health

University Park, Texas

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Baylor Scott & White Health

Highland Park, Texas

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Northeast Georgia Health System

Gainesville, Georgia

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Franciscan Physician Network

Lafayette, Indiana

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Maitland, Florida

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Daytona Beach, Florida

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Brookings, Oregon, Oregon

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AdventHealth

Daytona Beach, Florida

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Ocala, Florida

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Physician Reviewer
DescriptionScope: Serves as an expert physician resource and reviewer.REPRESENTATIVE RESPONSIBILITIES???Medical ReviewPerforms medical review activities pertaining to delegated pediatric services including medical review of complex, controversial, or experimental medical services???QualityAssists Medical Director in improving quality and cost-effectiveness of care and service for members and provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, institutional, and accreditation requirements???UtilizationIdentifies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of be


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