What are the responsibilities and job description for the Physician Reviewer position at W3R Consulting?
Apply: Email your resume to tezava@w3r.com or call 925-326-2471.
Job Title: Physician Reviewer
Location: Remote
Duration: 1-Year Contract
Schedule: Full-time (Monday-Friday) with possible weekend work
Pay Rate: Up to $115.00/hour on W2
Job Description:
The Physician Reviewer evaluates clinical service requests made by members and providers, using clinical judgment alongside organizational criteria. This role involves case reviews, anticipatory case management, and participating in appeal processes. The Physician Reviewer will also contribute to policy development and quality improvement initiatives within the unit.
⚠️ Note: This position does not involve direct patient care or medical diagnosis.
Key Responsibilities:
- Evaluate clinical service requests to determine medical necessity.
- Work collaboratively with case managers to anticipate and manage clinical situations.
- Conduct utilization management (UM) drug reviews as needed.
- Participate in appeals for service denials and contribute to policy development.
- Utilize electronic medical records (EMR) and computer-based review tools.
Required Qualifications:
- Board Certified (ABMS) M.D. or D.O. with an active, unrestricted license in any U.S. state.
- 5 years of clinical experience, including inpatient care.
- Understanding of managed care and strong computer proficiency for file reviews.
- Previous UM drug review experience preferred.
Salary : $115
