California Licensed Radiologist Reviewer

Job Summary

Providing physician-level radiology expertise, the full-time California Licensed Radiologist Reviewer will review radiology-related claims, Treatment Authorization Requests (TARs), and medical records remotely to ensure compliance with medical necessity and coverage requirements.

Key responsibilities

• Review radiology-related claims and medical records to evaluate compliance with medical policies and coverage requirements
• Provide clinical expertise for complex radiology cases and support medical necessity determinations
• Document review findings and collaborate with healthcare professionals to ensure accurate assessments

Required qualifications

• Minimum of three (3) years of experience as a Radiologist in a private, academic, or government setting
• Current, non-expired physician license from the State of California in good standing
• Not under suspension from Medicare, Medicaid, or practice in California
• Not previously sanctioned for fraud or abuse
• Strong clinical judgment with the ability to interpret complex radiology-related medical records