You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.
Job Summary
Our client is seeking a Clinical Reviewer to conduct utilization management overread of residential and inpatient denial decisions made by managed care entities for a state Department of Health Care Policy and Financing (HCPF). This project involves retrospective reviews and will not impact member care or prior service outcomes. The role entails making final determinations on escalated cases where first-level reviewers disagree with original denial decisions by MCEs.
Key Responsibilities
- Review escalated cases and render a final determination (agree/disagree with denial)
- Assess whether ASAM criteria were appropriately applied
- Utilize The ASAM Navigator by InterQual for determinations
- Document brief case summaries in Microsoft SharePoint
Qualifications
- MD only with an active, unrestricted medical license (DO not accepted)
- Board certification in Addiction Medicine (preferred)
- Active, unrestricted Colorado medical license (preferred)
Experience
- ASAM expertise and SUD treatment experience, ideally in inpatient or residential settings
- Utilization Management (UM) experience, including familiarity with medical necessity reviews, pre-authorizations, and navigating concurrent insurance reviews for addiction treatment levels of care
- InterQual experience (preferred)
Skills
- Proficiency with The ASAM Navigator by InterQual
- Proficiency in Microsoft SharePoint for documentation
Education
- Medical Doctor (MD) degree only
Additional Requirements
- Work is 100% remote
- Offers flexible hours within a standard Monday-Friday business schedule
- Project begins in August 2026
- Preference for candidates outside of Colorado
Benefits
- Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
- Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
- 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
- Short Term Disability Insurance.
- Term Life Insurance Plan.
*We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).
Medix Overview:
With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we’re dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.
Any required state or Joint Commission training is compensated at the state or local minimum wage rate.
*As a job position within our Care Management division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing financial and confidential information, access and handling of patient medical records, providing medical care inside a patient’s residential address, driving, prescription and other drug access and administration, and working with vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.
