Physical Medicine and Rehabilitation Physician Clinical Reviewer

Job Summary

A company is looking for a Physical Medicine and Rehabilitation Physician Clinical Reviewer.

Key Responsibilities:

• Serve as the Clinical Reviewer for cases that do not initially meet the applicable medical necessity guidelines
• Discuss determinations (peer to peer phone calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request
• Provide clinical rationale for standard and expedited appeals

Required Qualifications:

• DO/MD/MBBS Degree
• Board Certified by an American Certifying Board for Physical Medicine and Rehabilitation
• Current, Unrestricted License in one or more states
• 5 years post residency experience
• Must have practiced clinical medicine in the last 18 months