Physician Reviewer

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Hours: Mon-Fri Core business hours 40hr/week

As a Physician Reviewer, you'll play a critical role in ensuring that our members receive high-quality, cost-effective care. You'll work closely with our team to review clinical service requests, provide expert opinions, and develop policies and procedures that align with our organization's criteria. Your expertise will help us identify opportunities for creative problem-solving and anticipation of future clinical problems, ultimately driving better health outcomes for our members.

Responsibilities include reviewing clinical service requests, providing expert opinions, and contributing to the development of policies and procedures that align with organizational criteria to improve health outcomes for members.

• Board Certified (ABMS) M.D. or D.O., unrestricted and active license to practice medicine
• 5 years clinical experience, including inpatient experience, or equivalent education and experience
• Understanding of managed care and proficiency in PC (electronic medical records)
• Strong clinical judgment and analytical skills
• Excellent communication and interpersonal skills

• 10 years clinical experience
• Experience with managed care and utilization management
• Strong leadership and management skills

• Master's degree in Healthcare Administration, Public Health, or related field (optional)

• Ability to work independently and as part of a team
• Strong organizational and time management skills
• Ability to maintain confidentiality and handle sensitive information
• Willingness to participate in continuous quality improvement activities

• Opportunity to make a meaningful impact in the lives of our members
• Collaborative and dynamic work environment
• Professional development and growth opportunities