Secondary Physician Reviewer at Greenlife Healthcare Staffing Raceland, KY

Secondary Physician Reviewer – Russell, KY (#R10154)

Location: Russell, KY
Employment Type: Full-time
Hourly Rate: $115.00 - $120.00/hour

Greenlife Healthcare Staffing is a leading nationwide recruitment agency dedicated to connecting healthcare professionals with top-tier opportunities. We partner with hospitals, clinics, nursing homes, multi-specialty groups, and private practices to match talented individuals with roles that align with their skills and career goals.

Lead utilization management efforts by conducting critical second-level medical necessity reviews. Ensure optimal resource allocation and compliance with CMS/payer guidelines while driving cost-effective, high-quality patient care across diverse healthcare settings.

• Conduct second-level medical necessity reviews for concurrent and retrospective cases.
• Determine admission status, length of stay, and appropriate level of care.
• Review readmission cases for clinical relevance within a 30‑day window.
• Provide expert guidance for:
  • Medicare, Medicaid, and Commercial payers
  • First-level review escalations
  • Coding denial appeals
  • Government and Managed Medicare appeals
• Produce and present monthly reports and ongoing analysis of review outcomes.
• Ensure HIPAA‑compliant communications and secure data handling.

• Education: MD/DO from an accredited institution
• Licensure: Active medical license (good standing)
• Experience:
• At least 5 years’ experience in clinical review, hospital medicine, or utilization management.
• Expertise in federal and state payer guidelines, including CMS.
• Strong understanding of inpatient, observation, and outpatient criteria (e.g., Inter Qual, MCG).
• Technical
  
  Skills:
  
  
• Experience with electronic documentation systems and secure communications platforms.
• Peer‑level (physician) reviewers for a range of review/appeal tasks.
• Soft Skills:
• Analytical decision‑making
• HIPAA compliance

• Competitive Compensation: On‑Site:
  Monday - Friday, 24/7 electronic correspondence availability (including weekends and holidays) 8:00 a.m.
  
  - 5:00 p.m.
  
  - $115.00 per hour Phone support from 7:30 a.m.
  
  - 11:59 p.m.
  
  - $115.00 + $5.00 per hour
• Comprehensive Benefits: Premium compensation
• Professional Growth:
• Master federal/state payer regulations (CMS, Medicaid, Commercial)
• Influence system-wide resource utilization strategies