Job Description

Join Our Team as a Physician Reviewer (Remote) and Make a Difference!

Are you a dedicated and experienced physician looking to leverage your clinical expertise in a dynamic and impactful role? We are seeking a Physician Reviewer to join our team and contribute to our mission of providing exceptional healthcare services. This fully remote position offers flexibility and the opportunity to work from any state while making a significant impact on patient care.

Job Title: Physician Reviewer (Remote)

Location: Fully Remote - but must reside in the NASHVILLE, TN area

Job Type: Contract to hire

Required Hours:

• Monday-Friday 40 hours/week

Responsibilities:

• Evaluate clinical service requests from members and providers
• Utilize clinical judgment and organizational criteria to adjudicate requests
• Provide clinical leadership within the organization
• Identify opportunities to manage members' clinical situations through creative problem-solving
• Practice anticipatory case management in partnership with case managers
• Participate in the Physician Review Units' appeal process for service denials
• Contribute to the development of Physician Review Units' policies and procedures
• Actively participate in unit continuous quality improvement activities
• Perform other duties as assigned by the Medical Director

Qualifications:

• Board Certified (ABMS) M.D. or D.O. required
• Unrestricted and active license to practice medicine required
• Minimum 5 years of clinical experience, including inpatient experience
• Utilization Review experience
• Understanding of managed care principles
• Demonstrated PC proficiency for computer-based file reviews

Important Note: This position does not involve direct patient care or medical diagnosis.

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