Physician Reviewer

Job Responsibilities

• Medical Review - Performs medical review activities pertaining to delegated pediatric services including medical review of complex, controversial, or experimental medical services.
• Quality - Assists Medical Director in improving quality and cost-effectiveness of care and service for members and provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, institutional, and accreditation requirements.
• Utilization - Identifies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components. Identifies clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice in order to improve the quality and cost of care and interfaces with physicians and other providers in order to facilitate implementation of recommendations. Participates in robust interrater reliability audit process.
• Education - Assists in the development and implementation of physician education with respect to clinical issues and policies.
• Medical Leadership - Provides medical leadership for utilization management, cost containment, and medical quality improvement activities.

• M.D. or D.O.
• Board certification AND maintenance of certification
• Must have current, unrestricted license to practice medicine in the state of Ohio
• Previous experience in clinical medical practice
• Familiarity with the Ohio Department of Medicaid (ODM) provider agreement requirements and state regulations, including Ohio Revised Code (ORC) and Ohio Administration Code (OAC)
• Experience with managed care utilization management process and ability to communicate with physicians regarding clinical care decision guidelines
• Current, unrestricted MD or DO licensure in state(s) of practice

• Primary
  
  Location:
  
  Remote

• Schedule:
  
  Part time
• Shift: Day (United States of America)
• Department:
  Utilization Review
• Employee Status:
  Regular
• FTE: 0.25
• Weekly
  
  Hours:
  
  10

At Cincinnati Children’s, we come to work with one goal: to make children’s health better. We believe in a holistic team approach, both in caring for patients and their families, and in advancing science and discovery. We strive to do better and find energy and inspiration in our shared purpose. If you want to be the best you can be, you can do it at Cincinnati Children’s.

• Recognized by U.S. News & World Report as a top 10 best Children’s Hospital in the nation for more than 15 years
• Consistently among the top 3 Children’s Hospitals for NIH funding
• Recognized as one of America’s Best Large Employers (2025), America’s Best Employers for New Grads (2025)
• One of the nation’s America’s Most Innovative Companies as noted by Fortune
• Consistently certified as a great place to work
• A Leading Disability Employer as noted by the National Organization on Disability
• Magnet® designated for the fourth consecutive time by the American Nurses Credentialing Center (ANCC)

We Embrace Innovation—Together. We believe in empowering our teams with the tools that help us work smarter and care better. We support the responsible use of artificial intelligence. By encouraging innovation, we’re creating space for new ideas, better outcomes, and a stronger future—for all of us.

Comprehensive Job Description Provided Upon Request.

Cincinnati Children’s is proud to be an Equal Opportunity Employer committed to creating an environment of dignity and respect for all our employees, patients, and families. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, genetic information, national origin, sexual orientation, gender identity, disability or protected veteran status. EEO/Veteran/Disability