For Physicians
Physician Reviewer Master Class
Looking to enhance your career and improve our health system at scale? Joining a managed care organization as a physician reviewer is a meaningful opportunity to apply your clinical expertise to improve the quality and cost of care.
Determining medical necessity and ensuring the right care is provided at the right time, for the right patient, in the right setting is one of the most influential roles of a physician reviewer.
This course is ideal for practicing clinicians to acquire the knowledge, skills and mindset to succeed in health plan roles.
Learning structured to fit into clinicians' lives
Format
5 asynchronous sessions
8-10 hours total learning time
Case studies
Written & oral examination
Pre-requisites
Unrestricted physician license in state of practice
Board-certification
Not excluded by OIG or SAM
You will learn
Key concepts of Utilization Management and the role it plays in determining medical necessity
The roles that nurses and physicians play in UM
Medical Management processes to assure quality and cost effectiveness in clinical care delivery
The different aspects of Medical Management
The components of the Federal Medicare program
Various clinical criteria that are used and their differences
The different levels of appeals
The different metrics used to evaluate UM program effectiveness
Fees
$2,900 $499 discounted rate for first-cohort
Jay Pomerantz
MD, FACP, MMM
Dr. Pomerantz is Executive Medical Director at Toney Healthcare, bringing a wealth of experience in clinical practice and in population health. He has served as the Chief Medical officer for Farm Bureau Health Plans Tennessee, Senior VP and Chief Medical Officer at BCBS Western/Northeastern New York, and Regional VP and CMO for Utilization management at Excellus BCBS. He was Clinical Associate Professor of Medicine and Geriatrics at University of North Carolina.
Dr. Pomerantz is board certified in internal medicine and geriatrics and licensed in New York, North Carolina, Tennessee and Florida, and earned a Masters in Medical Management from Carnegie Mellon University.
Not Ready to Apply?
We’ll let you know when our next cohort opens.