Illinois Licensed Physician Reviewer

Job Summary

A company is looking for a Remote Physician Reviewer.

Key Responsibilities

• Review and evaluate clinical service requests from members and providers
• Apply clinical judgment and organizational guidelines to determine medical necessity
• Collaborate with case managers to support anticipatory case management

Qualifications

• M.D. or D.O. with active, unrestricted medical license
• Board Certification by an ABMS-recognized specialty board (Family, Internal, Emergency)
• Minimum 5 years of clinical experience, including inpatient care
• Prior experience in Utilization Review or Managed Care preferred
• Strong understanding of managed care principles and medical necessity criteria