Texas Licensed Medical Review Physician

Job Summary

A company is looking for a Telecommute Medical Review Stream Physician.

Key Responsibilities

• Reviews medical files and provides recommendations for utilization review, medical necessity, and appropriateness of care
• Maintains proper credentialing and state licenses while returning cases with clear rationales
• Telephonically contacts providers and interacts with healthcare professionals regarding claims and appeals

Required Qualifications, Training, and Education

• Board certified MD or DO with an understanding of managed care and utilization of services
• Current, unrestricted clinical license(s) or a process ensuring compliance with state restrictions
• Active medical practice is required for performing appeals
• Post-graduate experience in direct patient care
• Board certification by American Board of Medical Specialties or American Board of Osteopathic Specialties is required