Job Title: Physician Review
Location: Remote
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”):
$112 per hour
Job Description:
- Primary Function: Evaluate clinical service requests from members and providers using clinical judgment and organizational criteria.
- Additional Responsibilities:
- Provide clinical leadership in other organizational areas.
- Identify opportunities for proactive case management and creative problem-solving.
- Collaborate with case managers for anticipatory case management.
- Participate in:
- Physician Review Unit’s appeal process for service denials.
- Development of policies and procedures for the Physician Review Unit.
- Continuous quality improvement activities.
- Perform other duties as assigned by the Medical Director.
Qualifications
- Education & Certification:
- Board Certified (ABMS) M.D. or D.O.
- Active, unrestricted license to practice medicine.
- Experience:
- Minimum 5 years of clinical experience, including inpatient care.
- Or equivalent combination of education and experience.
- Skills:
- Understanding of managed care.
- Proficiency with PC systems (file review is computer-based).
- Note: This position does not involve direct patient care or medical diagnosis.
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