Licensed Physician Auditor

Job Summary

To support a contingent contract, the part-time Licensed Physician Auditor will perform blinded Independent Review clinical evaluations, assessing medical necessity and adherence to Medicare guidelines while collaborating on rebuttals and escalation decisions remotely.

Key responsibilities

• Perform blinded Independent Review clinical evaluations to assess medical necessity and appropriateness of care
• Collaborate in the development of rebuttals and contribute to informed escalation decisions

Required qualifications

• 10+ years of clinical practice experience in peer review, utilization review, or appeals
• Familiarity with CMS/QIO processes preferred
• Licensed MD or DO in the U.S. with an active, unrestricted license