State Licensed Physician Reviewer

Job Summary

A company is looking for a Physician Reviewer who will provide independent second-level determinations based on medical documentation and regulations.

Key Responsibilities

• Writes and plans reconsideration decisions that support determinations made
• Makes independent decisions based on medical evidence in accordance with relevant policies and regulations
• Conducts research to ensure accurate and well-supported decisions are made

Required Qualifications

• Doctor or PharmD degree from an accredited school
• Active State license to practice and board certification
• Five to seven years of clinical or direct patient care experience
• No federal or state sanctions as reported by the National Practitioner Data Bank (NPDB)
• Preferred experience with Medicare regulations or review