State Licensed Physician Reviewer

Job Summary

A company is looking for a Remote Physician Reviewer to leverage clinical expertise in a dynamic role.

Key Responsibilities

• Evaluate clinical service requests from members and providers
• Utilize clinical judgment to adjudicate requests and provide clinical leadership
• Participate in the appeal process for service denials and contribute to policy development

Required Qualifications

• Board Certified (ABMS) M.D. or D.O. required
• Unrestricted and active license to practice medicine required
• Minimum 7 years of clinical experience, including inpatient experience
• Utilization Review experience
• Understanding of managed care principles