Job Summary

An information technology advisory firm has a current position open for a Remote Medical Review Physician .

Candidates will be responsible for the following:

• Providing copies of any criteria utilized in a review to a requesting provider in a timely manner
• Telephonically contacting providers and interacts with other health professionals in a professional manner. Discusses the appropriate disclaimers and appeal process with the providers
• Returning cases in a timely manner with clear concise and complete rationales and documented criteria

Qualifications Include:

• Board certified MD, DO, with an excellent understanding of network services and managed care, appropriate utilization of services and credentialing, quality assurance and the development of policies that support these services
• Post-graduate experience in direct patient care
• Ability to work with various professionals including members of regulatory agencies, carriers, employers, nurses and health care professionals
• Knowledge of current practice standards in specialty
• Good negotiation and communication skills