External Physician Reviewer

AFMC is looking to contract with physicians to complete prior authorizations and retrospective reviews. Compensation is paid by review completed.

Specialists Needed
:

• Hematologist/Oncologist
• Pulmonologist
• Neurologist
• Cardiologist
• Gastroenterologist
• Urologist
• Geneticist
• Rheumatologist

Scope Of Services
:
The types of reviews AFMC Clinical Services completes are Medicaid prior authorizations and retrospective reviews.

• Perform assigned initial and reconsideration reviews such as:
• Prior authorizations for:
• Durable Medical Equipment, Hyperalimentation, Ventilators, and Wheelchairs
• Medical/Surgical Procedures and Hyperbaric Oxygen Treatment
• Physician Administered Drugs
• Molecular Pathology
• Retrospective reviews for:
• Inpatient Length of Stay
• Emergency Room
• Extension of Benefits
• Hospital Acquired Conditions
• Acute Crisis Unit
• Use AFMC ReviewPoint – a clinical review platform, when indicated.
• Maintain reliable internet with speeds of 2
  
  Mbps uploaded to maintain call quality and process integrity. +15
  
  Mbps download generally allows more fluid access to data and systems while lower speeds will result in increased lag time.
• Additional duties, as agreed upon.

Requirements
:

• Credentialing Qualifications
  :
  • Active, unrestricted license to practice medicine in Arkansas
  • Board-certified
  • Minimum of five (5) years full-time equivalent direct patient care experience
  • Direct patient care experience within the previous three (3) years
  • Maintain current liability and malpractice insurance coverage for non-UR clinical activities
  • Located in a state or territory of the United States when conducting appeal considerations
• Internet Requirements
  :
  Reliable, high-speed wireless internet service (Wi-Fi)

This is a Contract position at the Mid-Senior level in the Health Care Provider job function.