Remote Physician Reviewer - Utilization & Policy Lead

Folioworks; United States; Remote; USD 180.000 - 240.000; Vollzeit

Benefits dieser Stelle

Remote work arrangement

24-month contract

Weekend schedule after training

Holiday coverage possible

Zusammenfassung

Folioworks is seeking a remote contract physician reviewer to assess clinical service requests and apply criteria to determine appropriate care. The role involves case review, proactive management, and support for appeals, with opportunities to contribute to policy and quality improvements.

Requirements include board-certified MD or DO, an unrestricted license, and at least 5 years of clinical experience including inpatient work, plus a solid understanding of managed care.

Qualifikationen

• Board-certified MD or DO.
• Unrestricted and active medical license.
• At least 5 years of clinical experience, including inpatient experience.
• Understanding of managed care.
• Proficiency with computer-based work and electronic file review.

Aufgaben

• Evaluate clinical service requests and use clinical criteria to support determinations.
• Review cases in partnership with case managers to identify opportunities for proactive clinical management.
• Participate in the appeal process for service denials.
• Contribute to physician review policies, procedures, and continuous quality improvement activities.
• Provide clinical leadership and other duties as assigned by the Medical Director.
• Use computer-based file review workflows to assess documentation and case details.

Kenntnisse

Clinical judgement

Managed care understanding

Electronic file review

Remote work proficiency

Ausbildung

Board certified MD or DO

Jobbeschreibung

Folioworks is seeking a remote contract physician reviewer to assess clinical service requests and apply criteria to determine appropriate care. The role involves case review, proactive management, and support for appeals, with opportunities to contribute to policy and quality improvements.

Requirements include board-certified MD or DO, an unrestricted license, and at least 5 years of clinical experience including inpatient work, plus a solid understanding of managed care.