Texas Licensed Clinical Review Physician

Job Summary

A company is looking for a Utilization Clinical Review Physician to conduct clinical reviews and support medical benefit management remotely.

Key Responsibilities

• Conduct coverage reviews and render coverage determinations based on member plan benefits
• Document clinical review findings in accordance with policies and regulatory requirements
• Engage in peer-to-peer discussions with requesting providers and collaborate with network and non-network providers

Required Qualifications

• M.D. or D.O. degree
• Active board certification in an ABMS or AOBMS specialty
• Active unrestricted medical license and ability to obtain additional state licenses as needed
• 5+ years of clinical practice experience post-residency
• Proven understanding of Evidence Based Medicine (EBM)