Otolaryngologist Physician Reviewer

Job Summary

To support a growing utilization management team, the full-time Otolaryngologist Physician Reviewer will serve as a physician match reviewer for imaging cases, engage in peer-to-peer discussions with providers, and ensure compliance with medical review guidelines while working remotely.

Key responsibilities

• Serve as the physician match reviewer for imaging cases that do not meet medical necessity guidelines
• Engage in peer-to-peer discussions with requesting physicians, providing clinical rationale for determinations
• Utilize medical review guidelines to ensure consistency and compliance with policies and accreditation standards

Required qualifications

• MD/DO/MBBS with a minimum of five years of post-residency experience in medicine
• Active clinical practice within the last two years is 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