Insurance Utilization Review Jobs in Milwaukee, WI

Job Profile:
Faculty - Assistant Professor|Department of Pediatrics|Division of Community Pediatrics
Position Summary:
The Department of Pediatrics at the Medical College of Wisconsin (MCW) and Children's Wisconsin (CW), seeks a board certified / board eligible physician to join our expanding General and Community Pediatrics Section. We are comprised of nationally and internationally renowned, dedicated group of faculty and staff with a strong commitment to clinical care.
Position Highlights:

• Exhibits professional behaviors that model CW and MCW values, mission, and visions.
• Understands the growth and development needs of neonatal, infant, toddler, pre-school, school-age, and adolescent patients and utilizes this knowledge to provide outstanding delivery of care using a care team-based approach.
• Performs appropriate history, physical exam, assessments, and care plans. Documents this information into the electronic medical record concisely in a time compliant manner, and creates pertinent care plans utilizing the appropriate policies, rules, and regulations.
• Assesses and identifies all significant changes in patients' conditions and refers individuals to specialty providers as medically appropriate.
• Performs as a team player delivering care to patients and is responsive to urgent/emergent patient care situations as they arise and providing consultation to non-pediatrician providers.
• Participates and precepts pediatric residents, medical students and nurse practitioners, advanced practice providers by overseeing their medical education. Provides feedback to all learners regarding their progress in their respective medical skills. Engages in didactic prepared and adhoc primary care lectures/discussions to learners at all levels.
• Engages in regular school linked and community activities to improve the health and health knowledge of the neighborhood and schools along with creating sustainable relationships as a representative of MCW and CW. Helps to develop and foster relationships with local schools and community-based organizations that address community health and the social determinants of health.
• Participates in research and quality improvement studies as an investigator, a collaborator or a facilitator for studies conducted in the clinic and/or community.
• Provides, when requested, nursing in-service education.
• Timely answer third party payor and utilization review questions. Provide complete documentation of all procedures in the medical record for billing purposes.
• Uses a patient centered trauma informed care approach to manage patient needs effectively and efficiently. Communicates well with the parents, patients, etc. regarding the patient's care.
• Utilizes clinical patient care guidelines appropriately based on individual patient needs.
• Employs good communication and interpersonal skills when dealing with team members including fellow physicians, nurses, administrative and other staff.
• Models a culture of service to others.

Schedule:

• Full-time

Department/Division Highlights:
Community based providers will support the missions of both CW and MCW by pursuing direct community engagement and advocacy; actively participating in the teaching of learners at all levels; and engaging in scholarly works including but not limited to Community Based Participatory Research and/or Quality Improvement Opportunities. Community based providers will engage in appropriate pediatric and adolescent care services in a patient centered medical home and be responsible for examining, diagnosing, treating, and referring, as necessary, both well and ill children with a wide variety of injuries, acute and chronic conditions. Community based providers will function as a member of a multidisciplinary team in an integrated model of care.
Qualifications

• Medical degree (MD, DO, or equivalent) from an accredited institution.

• Board certification or eligibility in Pediatrics.

• State medical licensure, or eligibility to obtain license, in the state of Wisconsin.

• Rank will be determined by the qualifications and experience of the successful finalist.

Why MCW?

• MCW offers a competitive salary and comprehensive benefits package.
• Protected Academic time.
• Access to state-of-the-art facilities and resources.
• Supportive and collaborative work environment.
• A competitive 403(b) retirement plan with an 8% employer contribution.
• Generous CME allowance to cover societal dues, travel, and conferences.
• As a qualifying non-profit, employment with the Medical College of Wisconsin may make you eligible for the Public Service Loan Forgiveness (PSLF) program.
• Robust benefits package, including health, dental, life insurance, disability coverage, adoption assistance, paid parental leave, tuition reimbursement program, generous paid time off, and more!

Children's Wisconsin and Children's Specialty Group
Children's Wisconsin is an independent health care system dedicated solely to the health and well-being of children. The hospital, with locations in Milwaukee and Northeast Wisconsin, is recognized as one of the leading pediatric health care centers in the United States. Children's Wisconsin provides primary care, urgent care, emergency care, specialty care, mental and behavioral health services, community health services, foster and adoption services, child advocacy services and health insurance plans. Each year, the Children's Wisconsin team has more than 6.5 million touchpoints with kids and families through medical care, advocacy, research and education. In Northeast Wisconsin, Children's Wisconsin is expanding its services to provide increased access to outstanding pediatric subspecialty care. This includes a pediatric hospital, with a Pediatric Unit, Level III NICU and Infusion Center, which is located at ThedaCare Regional Medical Center in Neenah, WI. A multispecialty pediatric ambulatory clinic with on-site laboratory and radiology services opened in Appleton, Wis. in 2023.
Children's and its joint venture with the Medical College of Wisconsin - the Children's Specialty Group (CSG) - are the largest providers of pediatric healthcare in the state, serving the children and families of Wisconsin with the highest level of care through their American College of Surgeons Level I Children's Surgery Verification Center, Level I Pediatric Trauma Center, Diagnostic Imaging Center of Excellence, 72-bed Level IV NICU, Level IV Epilepsy Center, and a 72-bed PICU. In 2021-2022, CW and CSG had six specialties ranked by US News & World Report: cancer; cardiology and heart surgery; gastroenterology and GI surgery; neurology and neurosurgery; orthopedics; and pulmonology. With over 70 specialties and 675 providers, CSG providers had 220,000 outpatient visits at 13 regional care sites, 67,000 emergency department/trauma center visits, and over 9,000 admissions.
Procedure for Candidacy
To submit your application, please click on "Apply Now." You will create a candidate profile, and you will be prompted to upload your CV and your cover letter, describing your interest and qualifications. References will be required at an appropriate time in the process. All interactions will remain confidential, and no inquiries will be made without the consent of the applicant. Application review will begin immediately and continue until the position is filled.
For inquiries or to learn more, please contact:
Mikaela Messerschmidt, Physician & APP Recruiter
mmesserschmidt@mcw.edu
#LI-BLT1
Medical College of Wisconsin
The Medical College of Wisconsin (MCW) is the state's only private medical school and health sciences graduate school. MCW consists of a School of Medicine with campuses in Milwaukee, Green Bay and Central Wisconsin, a School of Graduate Studies, and a School of Pharmacy. MCW is a major national research center ranking in the top third of U.S. medical schools in NIH funding and is the second largest research institution in Wisconsin. Academic medicine is at the core of everything we do at MCW, bringing together scientists, clinicians, students and community members to solve the most complex challenges in health and society. MCW is a diverse group of thought leaders collaborating to pioneer pathways to a healthier world. Every study we conduct and every patient we see leads to new learning and a continuous cycle of life-changing knowledge and innovation.
Approximately 1,780 MCW physicians and approximately 905 advanced practice providers care for more than 484,000 patients of all ages annually at Froedtert Hospital, Zablocki VA Medical Center, Children's Wisconsin, and many other hospitals and clinics throughout eastern Wisconsin, representing more than 5.1 million patient visits annually.
The beautiful, safe and modern campus of the Milwaukee Regional Medical Center (MRMC) houses Froedtert Hospital, Children's Wisconsin, Curative Care Network, Versiti Blood Research Institute and the Milwaukee County Behavioral Health Division. These member entities share a common mission of excellence in patient care, medical education, biomedical research and community service.
Commitment to MCW Values
All of our endeavors at MCW, from our internal operations to our interactions with our partners, are driven by our shared organizational values: acting in Caring ways - engaging in Collaborative efforts - approaching our world with Curiosity - advancing Inclusive practices - demonstrating Integrity in all we do - treating everyone with Respect. We are committed to fostering an inclusive environment that values diversity in backgrounds, experiences and perspectives through merit-based processes, and in alignment with all applicable laws. We believe that embracing human differences is critical to realize our vision of a healthier world, and we recognize that a healthy and thriving community starts from within. Our values define who we are, what we stand for and how we conduct ourselves at MCW. If you believe in embracing individuality and working together according to these principles to improve health for all, then MCW is the place for you.
Milwaukee, the largest city in Wisconsin, is located on Lake Michigan's western shore. A metropolitan area with more than 1.6 million people, Milwaukee is an affordable, comfortable place to live, work, and play, big enough to be exciting and uncongested enough to get around easily. Milwaukee's many neighborhoods have incredible charm, accommodating a variety of lifestyles, from high-rise apartments to small farms. Nestled along a magnificent bluff overlooking Lake Michigan, Milwaukee's downtown is home to botanical gardens, lakefront museums, a theater district, the world champion Milwaukee Bucks, the Milwaukee Brewers, bustling nightlife, and award-winning restaurants. The lake and its harbors are skirted by scenic parklands and provide first-class opportunities for recreation, including hiking, cycling, boating, and more. A recent study ranked Milwaukee as the 15th most walkable of the 50 largest US cities. Milwaukee has all the advantages of a large, vibrant city but without the stress or cost.
MCW as an Equal Opportunity Employer and Commitment to Non-Discrimination
The Medical College of Wisconsin (MCW) is an Equal Opportunity Employer. We are committed to fostering an inclusive community of outstanding faculty, staff, and students, as well as ensuring equal educational opportunity, employment, and access to services, programs, and activities, without regard to an individual's race, color, national origin, religion, age, disability, sex, gender identity/expression, sexual orientation, marital status, pregnancy, predisposing genetic characteristic, or military status. Employees, students, applicants or other members of the MCW community (including but not limited to vendors, visitors, and guests) may not be subjected to harassment that is prohibited by law or treated adversely or retaliated against based upon a protected characteristic.