Part-Time Physician Reviewer ( Temp

Position

Part‑Time Physician Reviewer (SCAN Temp) – Remote – 20 hrs/week

• Provide medical guidance for utilization management operations (prior authorization, concurrent and retrospective review, claims payments).
• Serve as medical expert for medical policy questions under Medicare and SCAN guidelines, recommending process improvements.
• Conduct clinical review for corporate activities such as grievance and appeals.
• Engage in peer‑to‑peer discussion with Medical Directors of provider partners to reduce member pain points.
• Streamline corporate activity review escalation process to MD level when appropriate, aligning with Medicare, State, and SCAN guidelines.
• Provide medical expertise to the medical management team overseeing out‑of‑area members to optimize outcomes for quality of care and efficiency.
• Represent SCAN in Administrative Law Judge appeal cases.
• Participate in IDT rounds focused on quality of care and utilization management.
• Support implementation of performance improvement initiatives for 5‑star quality with provider partners.
• Review quality of care cases and provide recommendations to Credentialing and Peer Review committees.
• Review provider and facility claims including complex, controversial, and/or unusual or new services to determine medical necessity and appropriate payment.
• Contribute to team effort by identifying and achieving goals as needed.
• Actively support SCAN’s Vision and Goals and perform other duties as assigned.

• MD/Physician with unrestricted California State medical license (other state licenses required as business needs).
• Board certification in one ABMS category.
• Minimum five years active clinical practice in adult based primary care specialty (preferably Internal Medicine or Family Practice).
• Active or recent hospital experience within past five years strongly desirable.
• Experience in health plan/medical group operations.
• Experience in appeals and grievances review, utilization management, case review, and/or quality improvement activities in a managed care setting strongly desired.
• Strong knowledge of Medicare policies and guidelines required.
• Strong interpersonal, communication skills; commitment to detail.
• Demonstrated leadership and management skills.
• Strong clinical skills in creating evidence‑based utilization management, disease management, and quality improvement programs.

• Base salary range: $175–$200 per hour.
• Remote work.
• Medical benefits.
• Paid sick time.
• 401(k) retirement savings plan.
• Robust employee recognition program.
• Opportunity to make a difference to members and community.

SCAN is proud to be an Equal Employment Opportunity and affirmative action workplace. Candidates will receive consideration without regard to race, color, national origin, religion, age, sex, pregnancy, childbirth, sexual orientation, gender identity, marital status, disability, protected veteran status or any other status protected by law. A background check is required.

Applicants are encouraged to apply now.