Physician Reviewer Job at Mitchell Martin, Richardson, TX

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  • Mitchell Martin
  • Richardson, TX

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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