State Licensed Physician Reviewer

Job Summary

Conducting utilization reviews to determine medical necessity, the part-time Physician Reviewer will work remotely, collaborating with internal staff and providers while ensuring adherence to clinical and regulatory standards.

Key responsibilities

• Conduct medical necessity reviews and issue adverse determinations when appropriate
• Evaluate requests across post-acute care services in alignment with clinical standards
• Collaborate effectively with internal and external stakeholders to support evidence-based care decisions

Required qualifications

• MD or DO with an active, unrestricted medical license
• Current and unexpired board certification in a relevant specialty
• Minimum 3+ years of utilization management experience
• Minimum 3+ years of clinical practice experience, including inpatient care
• Experience with evidence-based clinical guidelines and regulatory criteria preferred