Remote Physician Reviewer: Clinical Appeals & Review (Contract)

Walker Healthforce, Inc.; Richardson (TX); Remote; USD 130,000 - 170,000; Full time

Benefits offered by this job

Weekly pay via Direct Deposit

Medical, Dental & Vision available

401k options

Job summary

Walker Healthforce is seeking a Physician Reviewer with 5+ years of clinical experience to provide clinical review of service requests remotely. The role requires board certified MD/DO, an active license, and inpatient experience. This is a W2 contract opportunity, with full-time hours and weekend coverage.

Start date ASAP. Responsibilities include evaluating requests, collaborating with case managers, and contributing to policy development and quality initiatives while supporting managed care

Qualifications

• 5+ years of clinical experience, including inpatient experience, or an equivalent combination of education and experience

Responsibilities

• Evaluate clinical service requests using clinical judgment and established criteria
• Identify opportunities for proactive management of members' clinical situations
• Collaborate with case managers on anticipatory case management
• Participate in appeals of service denials
• Support the development of clinical review policies and procedures
• Participate in continuous quality improvement activities
• Perform other duties as assigned by the Medical Director

Skills

5+ years clinical experience

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

Unrestricted medical license

Inpatient experience

Education

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

Tools

PC proficiency

Job description

Walker Healthforce is seeking a Physician Reviewer with 5+ years of clinical experience to provide clinical review of service requests remotely. The role requires board certified MD/DO, an active license, and inpatient experience. This is a W2 contract opportunity, with full-time hours and weekend coverage.

Start date ASAP. Responsibilities include evaluating requests, collaborating with case managers, and contributing to policy development and quality initiatives while supporting managed care