Remote Physician Reviewer | Contract-to-Hire

Walker Healthforce; Chicago (IL); Remoto; USD 96.000 - 165.000; Tempo parcial

Benefícios oferecidos por esta vaga

Competitive compensation package

Weekly pay via Direct Deposit

Medical, Dental & Vision available

401k options

Resumo da vaga

Walker Healthforce is seeking a Physician Reviewer with 5+ years' experience for a remote contract-to-hire role. The position involves evaluating clinical service requests, applying clinical judgment, and supporting policy development within the Physician Review Unit.

Candidates must be board-certified MD or DO with an active license and inpatient experience, plus a solid understanding of managed care. The role may require rotation and weekend coverage; compensation includes weekly pay and

Qualificações

• Board Certified (ABMS) M.D. or D.O, unrestricted and active license to practice medicine requested
• 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

Responsabilidades

• 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. 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.

Conhecimentos

Clinical judgment

PC proficiency

Managed care understanding

Formação

Board Certified MD/DO

Descrição da vaga

Walker Healthforce is seeking a Physician Reviewer with 5+ years' experience for a remote contract-to-hire role. The position involves evaluating clinical service requests, applying clinical judgment, and supporting policy development within the Physician Review Unit.

Candidates must be board-certified MD or DO with an active license and inpatient experience, plus a solid understanding of managed care. The role may require rotation and weekend coverage; compensation includes weekly pay and