Remote Physician Peer Reviewer – Multiple Specialties

FHAS, LLC; Pennsylvania; Hybride; USD 117 000 - 179 000; Plein temps

Résumé du poste

FHAS, LLC is seeking Physician Peer Reviewers with multiple specialties to review medical records and render determinations on medical necessity and related issues. Remote, contract-based roles involve independent review of cases across states, requiring licensure and board certification.

Candidates must have completed a residency/fellowship, hold an unrestricted US license, and possess ABMS/AOA board certification with 5+ years of post-graduate clinical experience; external reviews require

Qualifications

• Successful completion of a Residency or Fellowship Program.
• Must possess a current state license in a state of the United States/recognized in the relevant jurisdictions as a Doctor of Medicine or Doctor of Osteopathic Medicine and if required by contract, licensed in the state in which requests the review.
• License is unrestricted and if there is a restriction that is allowed by a relevant jurisdiction, according to the medical director or clinical director, it is of the type that does not affect the health professional’s ability to fulfill the roles and responsibilities of a reviewer.
• License is of the type and scope that permits applying clinical judgement in consideration of an individual members clinical needs to render a decision.
• For either a Doctor of Medicine or Doctor of Osteopathic Medicine, possess the same license or certification as the ordering practitioner.
• Must hold a current board certification issued by the American Board of Medical Specialties or American Osteopathic Association.
• 5-years or more post graduate clinical experience in direct patient care
• Experience providing direct patient care within the past 3 years, if performing external reviews

Responsabilités

• Responsible for reviewing medical case files and making medical determinations. Cases may include medical necessity and medical appropriateness, experimental or investigational treatment, administrative or legal issues, or a combination of these categories, which are filed with the Department of Human Services’ Bureau of Hearings and Appeals (BHA).
• Reviews and analyzes Federal and State laws, regulations, and applicable policy guides
• Completes and evaluates the review process in a regulatory timeframe.

Formation

Residency or Fellowship Program

Medical license (MD/DO) in US

ABMS/AOA board certification

Description du poste

FHAS, LLC is seeking Physician Peer Reviewers with multiple specialties to review medical records and render determinations on medical necessity and related issues. Remote, contract-based roles involve independent review of cases across states, requiring licensure and board certification.

Candidates must have completed a residency/fellowship, hold an unrestricted US license, and possess ABMS/AOA board certification with 5+ years of post-graduate clinical experience; external reviews require