Independent Medical Review Physician Multispecialties

FHAS Federal Hearings & Appeals Services, Inc.; Indiana (PA); Hybride; USD 120 000 - 170 000; Plein temps

Résumé du poste

FHAS Federal Hearings & Appeals Services, Inc. is seeking a Physician Peer Reviewer with multiple specialties to review medical claims and determine medical necessity and appropriateness for Federal and State review processes.

Candidates must hold an active medical license in Indiana or Nevada, be board-certified, and have 5+ years of post-graduate experience with recent direct patient care. The role requires independent judgment and timely completion of reviews.

Qualifications

• Completion of a Residency or Fellowship Program.
• Current state license in the United States in the relevant jurisdictions.
• Unrestricted license and no disqualifying restrictions.
• License permits applying clinical judgement in consideration of patient needs.
• Must have the same licensure as the ordering practitioner.
• Board certification by ABMS or AOA.
• 5+ years post-graduate clinical experience.
• Experience providing direct patient care within the past 3 years if performing external reviews.

Responsabilités

• Review medical case files and make medical determinations, including medical necessity and appropriateness.
• Review and analyze Federal and State laws, regulations, and policy guides.
• Complete and evaluate the review process within regulatory timeframes.

Formation

Residency or Fellowship Program

Description du poste

FHAS Federal Hearings & Appeals Services, Inc. is seeking a Physician Peer Reviewer with multiple specialties to review medical claims and determine medical necessity and appropriateness for Federal and State review processes.

Candidates must hold an active medical license in Indiana or Nevada, be board-certified, and have 5+ years of post-graduate experience with recent direct patient care. The role requires independent judgment and timely completion of reviews.