Physician Reviewer

Responsibilities

• Determine the medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines.
• Provide timely medical reviews that meet stringent quality parameters and meet appropriate turnaround times.
• Document all communication and decision‑making clearly and accurately in workflow tools.
• Conduct peer‑to‑peer discussions with treating providers to clarify clinical information and explain review outcome decisions.
• Receive and review escalated reviews and ensure compliance with all applicable laws and regulations.

Requirements

• Board certification as an MD or DO.
• Active medical license in FL, NC, or AZ, or possession of an active Interstate Medical Licensure Compact (IMLC).
• 6+ years of clinical practice experience.

Preferred Qualifications

• 1+ years of utilizatio...