Endocrinology Physician Reviewer

Job Summary

Seeking an Endocrinology Physician Reviewer, the full-time position will serve as a key member of the utilization management team in a remote setting, focusing on reviewing imaging cases for medical necessity and collaborating with physicians to provide clinical rationale for determinations.

Key responsibilities

• Review imaging cases that do not meet medical necessity guidelines and provide specialty reviews as required
• Engage in peer-to-peer discussions with requesting physicians to discuss determinations and provide clinical rationales
• Ensure compliance with medical review guidelines and maintain accurate documentation of communications with medical staff

Required qualifications

• MD/DO/MBBS degree
• Minimum of five years of medical practice experience, with active clinical practice within the last two years preferred
• Current, unrestricted clinical license in the home state or required specialty
• Active Board Certification by an accredited organization
• No history of major disciplinary or legal action by a state medical board