State Licensed Physician Reviewer

Job Summary

Serving as a key member of the utilization management team, the part-time State Licensed Physician Reviewer will conduct imaging case reviews, engage in peer-to-peer discussions with physicians, and ensure compliance with medical necessity guidelines while working remotely.

Key responsibilities

• Review imaging cases that do not meet medical necessity guidelines and provide clinical rationale for determinations
• Engage in peer-to-peer phone calls with requesting physicians to discuss review outcomes within regulatory timeframes
• Maintain accurate documentation of all communications and assist in ongoing training related to utilization management processes

Required qualifications

• MD/DO/MBBS with active, unrestricted clinical home state license
• Minimum of five years of medical practice experience post-residency, with active clinical practice within the last two years preferred
• Active Board Certification by an accredited organization
• Strong clinical and organizational skills, with proficiency in computer usage
• No history of major disciplinary actions or sanctions by any medical board or health care program