Physician Reviewer – Part Time

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

📋 Description

• Perform reviews of medical necessity for cases that might not fulfill established criteria and issue adverse determinations when necessary.

• Assess requests for post-acute care services in accordance with clinical and regulatory standards.

• Achieve or surpass Service Level Agreements (SLA) and performance commitments required by health plan clients.

• Utilize sound clinical judgment and uphold integrity in all decisions and interactions.

• Collaborate efficiently with both internal and external stakeholders, including providers and physicians.

• Undertake additional responsibilities as assigned.

⛳️ Requirements

• MD or DO with an active, unrestricted medical license (in states that comply with CareCentrix client payer requirements).

• Current and unexpired board certification in a pertinent specialty.

• At least 3 years of experience in utilization management (UM).

• A minimum of 3 years of clinical practice experience, including inpatient care.

• Preferred experience with evidence-based clinical guidelines (e.g., Milliman/InterQual), along with CMS and state-specific regulatory criteria.

🏝️ Benefits

• Comprehensive health insurance plans.

• Opportunities for professional development and continuing education.

• Supportive work environment that fosters collaboration and innovation.

• Competitive salary and performance-based incentives.