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,