Job Description

Title ; Healthcare - Physician Reviewer Location: Regional (Remote) Employment Type: Contract Compensation: Pay Range:$70.56-$100.80/Hrs Description:

• Evaluate clinical service requests from members and providers.
• Use clinical judgment and organization's criteria for adjudication.
• Provide clinical leadership and identify opportunities for creative problem-solving.
• Participate in anticipatory case management with case managers.
• Engage in the appeal process for service denials.
• Contribute to the development of unit policies and procedures.
• Actively engage in continuous quality improvement activities.

Key Responsibilities:

• Evaluate and adjudicate clinical service requests.
• Identify and manage potential clinical problems creatively.
• Participate in anticipatory case management with case managers.
• Engage in the appeal process for service denials.
• Contribute to policy and procedure development.
• Participate in quality improvement activities.

Qualifications:

• Board Certified (ABMS) M.D. or D.O, with unrestricted and active medical license.
• 5 years of clinical experience, including inpatient experience.
• Understanding of managed care.
• Demonstrated PC proficiency for file review.
• Preferred: 10 years of clinical experience, experience with managed care and utilization management.

Contact Information Lexi Small,[email protected] Benefits: Learn more about our benefits offerings here EEO Statement: Learn more about our EEO policy here #LI-LS1 Mitchell Martin

Job Tags

Contract work,

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