Physician Reviewer

Job Title:

Physician Reviewer

Location:

Illinois, Montana, New Mexico, Oklahoma or Texas.

Job Type: Contract

Expected hours per week (must include “per week”): 40 hours per week

Schedule (include days, hours, onsite/hybrid or remote):
Monday – Friday, Remote

Pay Range (must include “per hour”): $120.19 per hour

• Evaluates clinical service requests from members and providers using clinical judgment and organizational criteria.
• Provides clinical leadership and identifies opportunities for proactive case management.
• Participates in:
  • Physician Review Unit appeals for service denials.
  • Development of policies and procedures.
  • Continuous quality improvement activities.
• Works closely with case managers for anticipatory case management.
• 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 clinical experience, including inpatient care.
  • Understanding of managed care.
• Skills
  :
  • PC proficiency (file review via computer).
• Additional Notes
  :
  • No direct patient care or medical diagnosis.
  • Must reside in Illinois, Montana, New Mexico, Oklahoma, or Texas
    .