State Licensed Rheumatologist Reviewer

Job Summary

To support a growing utilization management team, the full-time State Licensed Rheumatologist Reviewer will serve as a physician match reviewer for imaging cases, discuss determinations with requesting physicians, and ensure compliance with medical review guidelines while working remotely.

Key responsibilities:

• Serve as the physician match reviewer for imaging cases that do not meet medical necessity guidelines
• Conduct peer-to-peer discussions with requesting physicians, providing clinical rationale for determinations
• Utilize medical review guidelines to ensure consistency and compliance with relevant accreditation standards

Required qualifications:

• MD/DO/MBBS with active Board Certification by an accredited organization
• A minimum of five years' experience in the practice of medicine, with active clinical practice within the last two years preferred
• Current, unrestricted clinical license in the home state or required specialty
• Strong clinical and organizational skills, with a passion for quality in health care
• No history of major disciplinary actions by a state medical board or exclusion from federal health care programs