State Licensed Physician Reviewer

Job Summary

A company is looking for a Physician Reviewer (Weekend Work).

Key Responsibilities

• Writes and plans reconsideration decisions that are clear and support the determinations made
• Makes independent decisions based on medical evidence in accordance with relevant statutes and policies
• Conducts research to ensure all appeal issues are addressed and decisions are well-supported

Required Qualifications

• Doctor or PharmD degree from an accredited school
• Active State license to practice
• Board certification
• Five (5) to Seven (7) years of clinical or direct patient care experience
• Experience with Medicare regulations or review preferred