Insurance Utilization Review Jobs in Indiana (NOW HIRING)

The Pediatrician provides comprehensive, patient-centered pediatric care while supporting the clinical, operational, and quality goals of Jane Pauley Community Health Center (JPCHC). This role delivers direct clinical services, supervises care provided by clinical team members, and partners with practice leadership to ensure high-quality, compliant, and fiscally responsible care.

The Pediatrician actively participates in quality improvement initiatives, care coordination, and organizational programs that advance JPCHC's mission to provide accessible, integrated healthcare to the communities we serve.

Job Responsibilities (include but are not limited to):

• Provide direct pediatric services in accordance with JPCHC clinical standards, policies, and scope of practice.

• Maintain full-time, on-site pediatric coverage as assigned.

• Provide medical direction and supervision to clinical staff and other individuals delivering patient care under the Pediatrician's oversight.

• Participate in equitable call coverage with other full-time JPCHC Pediatricians.

  • Call coverage will be assigned based on departmental need and will not exceed fifteen (15) days per month for more than two (2) consecutive months unless otherwise agreed upon.

  • Reasonable planning will occur in advance of scheduled leaves of absence.

• Participate in patient satisfaction initiatives and surveys as requested.

• Participate in managed care and third-party payer programs designated by JPCHC, including Medicare, Medicaid, and value-based or at-risk programs.

• Utilize JPCHC inpatient and outpatient facilities and refer patients within the JPCHC network when appropriate, except when:

  • The patient expresses a preference for another provider;

  • Insurance requirements dictate referral outside the network; or

  • Referral is not in the patient's best interest based on professional medical judgment.

• Perform additional pediatric duties as reasonably requested to support patient care and organizational needs.

• Ensure compliance with all applicable licensing, regulatory, and accrediting body requirements at the practice site.

• Assist with third-party billing matters, including Medicare, Medicaid, and commercial payer requirements, as needed.

• Assume responsibility for supervising the clinical and professional care provided by non-physician staff working under the Pediatrician's direction.

• Provide consultation and input on staffing, workflow, and operational decisions in collaboration with practice leadership (final decisions rest with JPCHC leadership).

• Assist with recruitment, onboarding, and orientation of new physicians at the practice site.

• Participate in quality assessment, utilization review, and quality improvement initiatives, including Medical Staff meetings and committees.

• Support development and implementation of quality assurance, utilization review, and clinical pathway programs, integrating findings into clinical practice.

• Contribute to fiscally responsible operations through participation in utilization review and quality assurance programs.

• Support collaborative, team-based care models that improve patient outcomes, care coordination, and cost effectiveness.

• Perform additional administrative duties as reasonably requested to support organizational goals.

• MD or DO required

• Board Certified or Board Eligible in Pediatrics

  • American Board of Pediatrics (ABP)

• Active Indiana Medical License (or ability to obtain prior to start date)

• Active DEA and Indiana Controlled Substance Registration (CSR) (or eligibility to obtain)

• Commitment to serving underserved and diverse populations

• Strong communication, leadership, and team collaboration skills

• Experience in an FQHC, community health center, or safety-net setting preferred

You'll join a mission-driven organization committed to equitable access, integrated care, and continuous improvement. This role offers the opportunity to shape clinical excellence across multiple sites while supporting providers and teams serving diverse and underserved communities.