Job Title: Physician Reviewer
Location: Illinois, Montana, New Mexico, Oklahoma or Texas.
Job Type: Contract
Expected hours per week (must include “per week”):
40 hours per week
Schedule (include days, hours, onsite/hybrid or remote):
Monday – Friday, Remote
Pay Range (must include “per hour”):
$120.19 per hour
Job Description:
Role Overview
- Evaluates clinical service requests from members and providers using clinical judgment and organizational criteria.
- Provides clinical leadership and identifies opportunities for proactive case management.
- Participates in:
- Physician Review Unit appeals for service denials.
- Development of policies and procedures.
- Continuous quality improvement activities.
- Works closely with case managers for anticipatory case management.
- Other duties as assigned by the Medical Director.
Requirements
- Education & Certification:
- Board Certified (ABMS) M.D. or D.O.
- Active, unrestricted license to practice medicine.
- Experience:
- Minimum 5 years clinical experience, including inpatient care.
- Understanding of managed care.
- Skills:
- PC proficiency (file review via computer).
- Additional Notes:
- No direct patient care or medical diagnosis.
- Must reside in Illinois, Montana, New Mexico, Oklahoma, or Texas.
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