Job Description

If you are interested, please forward your current resume to [email protected] and you can also reach me at 925-326-2471 to discuss your career aspirations.

Job Title: Physician Reviewer

Location: Remote, Nashville

Duration: 12 Months Contract

Pay Rate: $115.00/hour on W2

Note: This position will M-F 40 hours per week

Description:

• Evaluates clinical service requests made by an organization's members and providers.
• Uses clinical judgment in conjunction with organization's criteria to adjudicate these requests.
• May also provide clinical leadership in other areas of the organization. Identifies opportunities to manage members' clinical situations with a view toward creative problem solving and anticipation of possible future clinical problems for the member.
• Participates in the process to evaluate clinical service requests. Practices anticipatory case management for members whose cases come for review, in partnership with case managers. Participates in the Physician Review Units' appeal process of service denials.
• Participates in the development of Physician Review Units' policies and procedures.
• Actively participates in all unit continuous quality improvement activities.
• Other duties as assigned by the Medical Director.

Required Qualification(s): (No Value)

Board Certified (ABMS) M.D. or D.O, unrestricted and active license to practice medicine requested and 5 years clinical experience to include inpatient experience, or any combination of education/experience that would provide an equivalent background.

• Must have understanding of managed care and demonstrate PC proficiency, as file review will be done via computer in most cases.

Job Tags

Similar Jobs