PHYSICIAN REVIEWER at The Judge Group Inc. in Philadelphia, Pennsylvania

Job Description:

Location: REMOTE

Salary: $95.00 USD Hourly - $105.00 USD Hourly

Description: Our client is currently seeking a PHYSICIAN REVIEWER (REMOTE)
Can work in any state (part-time)


This position requires an initial time commitment to undergo and complete training.


After training, physician medical reviewer will provide weekend coverage, 8 hour shifts per Saturday and Sunday per month.


This job will have the following responsibilities:

• 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.
  
  


• Practices anticipatory case management for members whose cases come for review, in partnership with case managers.
  
  


• 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.
  
  

Qualifications & Requirements:

• Must be board Certified, M.D. or D.O with an unrestricted physician license in a state or territory of the United States.
  
  
  
  


• 5 years clinical experience to include inpatient experience, or any combination of education/experience that would provide an equivalent background.
  
  


• Must understand managed care and demonstrate PC proficiency, as file review will be done via computer in most cases.
  
  


• (Note: Position does not provide direct patient care or medical diagnosis.)
  
  

Contact: mraghavendra@judge.com


This job and many more are available through The Judge Group. Find us on the web at www.judge.com Apply Now