Job Summary

A healthcare company needs applicants for an opening for a Telecommute Physician Clinical Reviewer in Chicago.

Must be able to:

• Review all cases in which clinical determinations cannot be made by the Initial Clinical Reviewer
• Provide clinical rationale for standard and expedited appeals
• Assist the Senior Medical Director in research activities/questions related to the Utilization Management process

Required Skills:

• Reviews appeal cases and/or attends hearings for discussion of utilization management decisions
• Education: MD
• License and Certifications - Required
• Current, unrestricted license to practice medicine in one or more states of the United States
• Graduate degree from an accredited medical school
• Familiarity with the principles and procedures of utilization management as practiced in managed care organizations