State Licensed Physician Reviewer

Job Summary

A company is looking for a Physician Reviewer.

Key Responsibilities

• Evaluate clinical service requests made by members and providers
• Use clinical judgment to adjudicate requests based on organizational criteria
• Participate in continuous quality improvement activities and policy development

Required Qualifications

• Board Certified (ABMS) M.D. or D.O. with an unrestricted and active medical license
• Minimum of 5 years of clinical experience, including inpatient experience
• Understanding of managed care and proficiency in computer file review
• New Mexico licensure preferred but not required