Medical Reviewer, Radiologist

This is a fully remote position, open to applicants in California.

📋 Description

• Analyze claims related to radiology, Treatment Authorization Requests (TARs), medical records, and associated clinical documentation.

• Assess imaging and radiology services in accordance with relevant medical policies, coverage criteria, and clinical guidelines.

• Offer physician-level medical evaluations and clinical insight for intricate radiology cases.

• Assist in determining the medical necessity and appropriateness of requested or billed radiology services.

• Clearly and accurately document review outcomes, decisions, and the clinical rationale supporting them.

• Refer or collaborate on cases that require additional clinical expertise when necessary.

• Work together with physicians, nurses, other clinical experts, operations teams, and business partners.

• Stay updated on relevant radiology standards, medical policies, coverage criteria, and regulatory guidelines.

• Achieve established standards for quality, accuracy, productivity, and turnaround time.

• Primarily work from a home office, providing support to Medical Review Services for healthcare programs in California.

• Utilize various computer systems and applications to perform reviews, document findings, and facilitate timely decisions.

⛳️ Requirements

• At least three (3) years of experience as a Radiologist in a private, academic, or governmental environment.

• Active, non-expired physician license from the State of California, in good standing.

• Must not be currently suspended from Medicare, Medicaid, or practicing in California.

• Must not have a prior record of sanctions for fraud or abuse.

• Excellent oral and written communication abilities.

• Strong clinical judgment and capability to interpret complex radiology-related medical records and supporting documentation.

• Maintain all professional licenses, certifications, and credentials required for the role in an active, unrestricted, and good-standing status.

🏝️ Benefits

• Flexible hours.

• Work-life balance.

• Continuous learning and career development opportunities.

• Generous and flexible vacation policy.

• 401(k) employer match.

• Comprehensive health benefits.

• Educational assistance.

• Leadership and technical development academies.

• Ongoing training and support.