Remote Medical Clinical Reviewer - MD/DO

Integrity Management Services, Inc.; Alexandria (VA); Remote; USD 110,000 - 200,000; Full time

Job summary

Integrity Management Services, Inc. is hiring a Medical Clinical Review Consultant to provide expert medical evaluations of healthcare claims, reviewing records, treatment plans, and diagnostic data to determine medical necessity and quality of care.

The role supports Medicaid-related reviews and requires an active medical license and 2+ years of clinical experience. The position offers remote work within the United States, emphasizes HIPAA compliance, and adherence to data security standards

Qualifications

• Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) from an accredited medical school.
• Current, active, and unrestricted medical license in at least one U.S. state or jurisdiction.
• License in good standing with no restrictions affecting clinical reviews.
• Minimum of two years of professional clinical experience.
• Strong knowledge of medical terminology, clinical practice, and standards of care.
• Ability to interpret medical records, diagnostic results, imaging, and documentation.
• Ability to document findings clearly and concisely.
• Ability to work independently in a remote environment and meet timelines.

Responsibilities

• Conduct independent clinical reviews of healthcare claims and supporting documentation.
• Review medical records, treatment plans, clinical notes, diagnostics, imaging and other relevant information.
• Evaluate services for medical necessity and alignment with accepted standards of care.
• Assess documentation supporting billed services and levels of care.
• Apply Medicaid policies and clinical criteria when forming determinations.
• Identify potentially unnecessary or unsupported services based on clinical data.
• Develop clear, objective clinical determinations with rationale.
• Respond to requests for clarification and escalate complex questions when needed.
• Maintain consistency, accuracy, and objectivity across reviews.

Skills

Medical terminology

Analytical thinking

Documentation

Remote environment

Education

MD/DO degree

Tools

CPT/HCPCS

ICD-10-CM

Job description

Integrity Management Services, Inc. is hiring a Medical Clinical Review Consultant to provide expert medical evaluations of healthcare claims, reviewing records, treatment plans, and diagnostic data to determine medical necessity and quality of care.

The role supports Medicaid-related reviews and requires an active medical license and 2+ years of clinical experience. The position offers remote work within the United States, emphasizes HIPAA compliance, and adherence to data security standards