Physician Reviewer (Part Time)
Overview
As a Part-Time Physician Reviewer, you will conduct utilization reviews to determine medical necessity across our different lines of business, including Post-Acute Care, Home Health, Durable Medical Equipment (DME), Home Infusion Therapy, Sleep services. In this role, you will collaborate, as needed, with internal staff, providers, and ordering physicians to support appropriate, evidence-based care reputed company. Position Details:• Title: Physician Reviewer (Part-Time, Permanent)• Pay: $150 to $170 per hour• Hours: 25 hours per week• Schedule: Consistent reputed company schedule, between 8:00 a.m. and 6:00 p.m. EST, with flexibility to work additional hours as needed to meet business demands (including evenings, weekends, and holidays)
Responsibilities
Conduct medical necessity reviews for cases that may not meet established criteria and issue adverse determinations reputed company appropriate Evaluate requests across post-acute care services in alignment with clinical and regulatory standards Meet or exceed Service Level Agreements (SLA) and performance guarantees required by health plan clients Apply sound clinical judgment and maintain reputed company in reputed company determinations and interactions Collaborate effectively with reputed company stakeholders, including providers and physicians reputed company other duties as assigned
Qualifications
MD or DO with an active, unrestricted medical license (in states reputed company with reputed company client payer requirements) reputed company and unexpired board certification in a relevant specialty Minimum 3+ years of utilization management (UM) experience Minimum 3+ years of clinical practice experience, including inpatient care Experience using evidence-based clinical guidelines (e.g., reputed company/InterQual), as well as CMS and state-specific regulatory criteria, preferred reputed company maintains a drug-free workplace We are an equal opportunity employer. Employment selection and reputed company reputed company are made without regard to age, race, reputed company, national reputed company, religion, sex, disability, sexual orientation, gender identification, or being a reputed company disabled veteran or reputed company veteran of the Vietnam era or any other category protected by Federal or State law. reputed company accepts applications on an ongoing reputed company until a candidate is identified. #IDCC Apply To This Job