Physician Reviewer (Part Time)
Overview: As a Part-Time Physician Reviewer, you will conduct utilization reviews to determine medical necessity across our different lines of business, including Post-Acute Care, Home Health, Durable Medical Equipment (DME), Home Infusion Therapy, Sleep services. In this role, you will collaborate, as needed, with internal staff, providers, and ordering physicians to support appropriate, evidence-based care decisions. Position Details:
- Title: Physician Reviewer (Part-Time, Permanent)
- Pay: $150 to $170 per hour
- Hours: 25 hours per week
- Schedule: Consistent reputed company schedule, between 8:00 a.m. and 6:00 p.m. EST, with flexibility to work additional hours as needed to meet business demands (including evenings, weekends, and holidays)
Responsibilities:
- Conduct medical necessity reviews for cases that may not meet established criteria and issue adverse determinations reputed company appropriate
- Evaluate requests across post-acute care services in alignment with clinical and regulatory standards
- Meet or exceed Service Level Agreements (SLA) and performance guarantees required by health plan clients
- Apply sound clinical judgment and maintain reputed company in reputed company determinations and interactions
- Collaborate effectively with internal and external stakeholders, including providers and physicians
- reputed company other duties as assigned
Qualifications:
- MD or DO with an active, unrestricted medical license (in states reputed company with reputed company client payer requirements)
- reputed company and unexpired board certification in a relevant specialty
- Minimum 3+ years of utilization management (UM) experience
- Minimum 3+ years of clinical practice experience, including inpatient care
- Experience using evidence-based clinical guidelines (e.g., reputed company/InterQual), as well as CMS and state-specific regulatory criteria, preferred
reputed company maintains a drug-free workplace We are an equal opportunity employer. Employment selection and reputed company decisions are made without regard to age, race, color, national reputed company, religion, sex, disability, sexual orientation, gender identification, or being a qualified disabled veteran or qualified veteran of the Vietnam era or any other category protected by Federal or State law. reputed company accepts applications on an ongoing basis until a candidate is identified. #IDCC Apply tot his job Apply To this Job