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CareCentrix

Empowering Health at Home

Physician Reviewer – Part Time

GeneralGeneralPart TimeRemoteSeniorTeam 1,001-5,000Since 1996H1B SponsorCompany SiteLinkedIn

Location

United States

Posted

1 day ago

Salary

$150 - $170 / hour

Seniority

Senior

Postgraduate Degree3 yrs expEnglish

Job Description

Physician Reviewer – Part Time

CareCentrix

• Conduct medical necessity reviews for cases that may not meet established criteria and issue adverse determinations when appropriate • Evaluate requests across post-acute care services in alignment with clinical and regulatory standards • Meet or exceed Service Level Agreements (SLA) and performance guarantees required by health plan clients • Apply sound clinical judgment and maintain integrity in all determinations and interactions • Collaborate effectively with internal and external stakeholders, including providers and physicians • Perform other duties as assigned

Job Requirements

  • MD or DO with an active, unrestricted medical license (in states aligned with CareCentrix client payer requirements)
  • Current and unexpired board certification in a relevant specialty
  • Minimum 3+ years of utilization management (UM) experience
  • Minimum 3+ years of clinical practice experience, including inpatient care
  • Experience using evidence-based clinical guidelines (e.g., Milliman/InterQual), as well as CMS and state-specific regulatory criteria, preferred

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