New York Licensed Physician Reviewer

Job Summary

A company is looking for a Physician Reviewer, Utilization Management, Remote.

Key Responsibilities

• Provides medical determinations for Utilization Management, including review of clinical information against evidence-based guidelines
• Reviews internal and external rationales related to coverage decisions and relevant medical records
• Ensures compliance with deadlines and participates in interdisciplinary rounds and special projects

Required Qualifications

• Licensed to practice medicine in the state of residence; New York State preferred
• Medical Degree required
• Minimum five years of experience in clinical medicine, including three years in managed care
• Strong knowledge of Medicare and Medicaid regulatory and reporting requirements
• Board Certification in Internal or Family Medicine preferred; Certification in Geriatric Care preferred