As a Temporary Physician Reviewer you will conduct utilization reviews for medical necessity determinations. As appropriate and when required, this position interfaces with the internal staff, Providers, and ordering physicians.

Hours - up to 15 hours per week (including weekends/holidays coverage)

Responsibilities

Conducts medical necessity review on cases that may not meet criteria, and issues adverse determinations as needed.
Achieves Service Level Agreement (SLA) metrics and performance guarantees as required by health plan clients
Ability to work various hours, up to 15 hours a week (including weekends/holidays)
Other duties as appropriate

Qualifications

MD or DO with an active and unencumbered medical licenses
Appropriate current and unexpired specialty board certifications
3 plus years of UM experience
3 plus years of clinical practice including inpatient experience
Prior experience utilizing evidence-based clinical guidelines (e.g., Milliman/Interqual) is preferred

We are an equal opportunity employer. Employment selection and related decisions are made without regard to age, race, color, national origin, religion, sex, disability, sexual orientation, gender identification, or being a qualified disabled veteran or qualified veteran of the Vietnam era or any other category protected by Federal or State l

Physician Reviewer - Remote - Temp/Contract