Pennsylvania Licensed Sports Medicine Reviewer

Job Summary

A company is looking for a 1099 Utilization Review for Sports Medicine Physicians.

Key Responsibilities

• Evaluate medical records to determine the medical necessity and appropriateness of healthcare services
• Review documentation against evidence-based criteria such as InterQual and MCG
• Ensure compliance with regulatory and health plan requirements in healthcare delivery

Required Qualifications, Training, and Education

• MD or DO, currently Board Certified in Sports Medicine and Family Medicine
• Minimum 5 years of direct clinical experience in Family Medicine, including residency
• Unrestricted, current medical license in Pennsylvania
• Willingness and availability for daytime peer-to-peer conversations
• Must be a U.S. Citizen or Green Card holder