What are the responsibilities and job description for the Physician Reviewer-Remote position at HireOps Staffing, LLC?
Description:
Physician Reviewer, Fully Remote
This is a contract to hire opportunity. Pay rate is $105/hour
Required hours: Monday through Friday, 9a-6p
Evaluates clinical service requests made by an organization's members and providers. Uses clinical judgment in conjunction with the 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 anticipating possible future clinical problems for the member. Participates in the process of evaluating 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.
Board Certified (ABMS) M.D. or D.O, unrestricted and active license to practice medicine requested, and 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. (Note: Position does not provide direct patient care or medical diagnosis.)
Required Qualification(s) MD/DO with clinical experience.
Preferred Qualification(s): Clinical experience more than 10 years. Utilization Management experience.
Salary : $105
