Physician Reviewer

Mastech Digital; United States; Remote; USD 60,000 - 80,000; Full time

Job summary

An established industry player is seeking a dedicated healthcare professional to join their team in a remote capacity. This full-time role involves evaluating clinical service requests and providing clinical leadership while managing members' clinical situations. Ideal candidates will possess a Board Certified M.D. or D.O. with substantial clinical experience, particularly in UM drug review. This position offers a unique opportunity to impact patient care indirectly while working alongside case managers and participating in continuous quality improvement initiatives. If you're passionate about healthcare and looking for a role that combines clinical expertise with problem-solving, this could be the perfect fit for you.

Qualifications

• Must have an unrestricted and active license to practice medicine.
• Experience in UM drug review is preferred.

Responsibilities

• Evaluate clinical service requests using clinical judgment.
• Participate in the appeal process of service denials.

Skills

Clinical Judgment

Problem Solving

Clinical Leadership

Managed Care Understanding

Education

Board Certified (ABMS) M.D. or D.O.

5 years clinical experience

Tools

PC Proficiency

Job description

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Base pay range

$115.00/hr - $115.00/hr

Duration: 24+ months Contract

Candidates Based in (OK, NM, IL, TX and MT) can apply

This position is full-time Mon-Friday and possibly weekend work as needed

This is remote in any of our five plan states (OK, NM, IL, TX and MT), but IL and TX are preferred

Required Qualifications:

Previous UM drug review experience is also preferred.

Evaluates clinical service requests made by an organization's members and providers. Uses clinical judgment in conjunction with organization's criteria to adjudicate these requests. May also provide clinical leadership in other areas of the organization. Identifies opportunities to manage members' clinical situations with a view toward creative problem solving and anticipation of possible future clinical problems for the member. Participates in the process to evaluate clinical service requests. Practices anticipatory case management for members whose cases come for review, in partnership with case managers. Participates in the Physician Review Units' appeal process of service denials. Participates in the development of Physician Review Units' policies and procedures. Actively participates in all unit continuous quality improvement activities. Other duties as assigned by the Medical Director. Board Certified (ABMS) M.D. or D.O, unrestricted and active license to practice medicine requested and 5 years clinical experience to include inpatient experience, or any combination of education/experience that would provide an equivalent background. Must have understanding of managed care and demonstrate PC proficiency, as file review will be done via computer in most cases. (Note: Position does not provide direct patient care or medical diagnosis.)

Seniority level

• Director

Employment type

• Full-time

Job function

• Health Care Provider and Other
• Industries: Health and Human Services and Hospitals and Health Care