Physician Reviewer

Job Title:

Physician Review

Location:

Remote

Job Type: Contract

Expected hours per week: 40 hours per week

Schedule:

Monday – Friday, Remote

Pay Range: $112 per hour

• Primary Function:
  Evaluate clinical service requests from members and providers using clinical judgment and organizational criteria.
• Additional Responsibilities:
  • Provide clinical leadership in other organizational areas.
  • Identify opportunities for proactive case management and creative problem-solving.
  • Collaborate with case managers for anticipatory case management.
  • Participate in:
    • Physician Review Unit’s appeal process for service denials.
    • Development of policies and procedures for the Physician Review Unit.
    • Continuous quality improvement activities.
  • Perform other duties as assigned by the Medical Director.

• Education & Certification:
  • Board Certified (ABMS) M.D. or D.O.
  • Active, unrestricted license to practice medicine.
• Experience:
  • Minimum 5 years of clinical experience, including inpatient care.
  • Or equivalent combination of education and experience.
• Skills:
  • Understanding of managed care.
  • Proficiency with PC systems (file review is computer-based).
• Note:
  This position does not involve direct patient care or medical diagnosis.