Lic En Medicina

We are seeking a **Bilingual Physician** with strong clinical knowledge and exceptional communication skills to support our healthcare management operations.
This role involves providing medical oversight in areas such as **admissions review, case management, discharge planning**, and **utilization review**.
You will play a key part in ensuring appropriate healthcare delivery and compliance with medical necessity and reimbursement guidelines.
**Key Responsibilities**:
- Evaluate **admission and service requests** (prospective, concurrent, and retrospective) for **medical necessity and policy compliance**.
- Act as a **liaison** between attending physicians and physician advisors to align on care plans and documentation requirements.
- Support **case management and discharge planning** by offering clinical input and guidance.
- **Document denial information** and resolution efforts in the **electronic medical record (EMR)** system.
- Ensure **payor com...