Position: Physician Reviewer
Location: Remote in Texas (must have Texas Medical Licensure)
Schedule: M-F 7-8 hours per day for 39 hours per week. Flex Sat/Sun as needed.
Pay: $110 per hour
Job Description:
The physician reviewer evaluates clinical service requests based on company guidelines to make medical necessity determinations. May also provide clinical leadership in other areas of the organization. Identifies opportunities to manage members’ clinical situations with a view toward creative problem solving and anticipation of possible future clinical problems for the member. Participates in the process to evaluate clinical service requests. Practices anticipatory case management for members whose cases come for review, in partnership with case managers. Participates in the development of Physician Review Units’ policies and procedures. Actively participates in all unit continuous quality improvement activities. Other duties as assigned by the Medical Director.
Required Education/Skills:
- Must be Board Certified, M.D. or D.O with an unrestricted physician license in Texas.
- Must demonstrate PC proficiency, as file review will be done via computer in most cases.
- 5 years clinical experience to include inpatient experience, or any combination of education/experience that would provide an equivalent background.
(Note: Position does not provide direct patient care or medical diagnosis.)