Empowering Health at Home
Physician Reviewer – Part Time
Location
United States
Posted
1 day ago
Salary
$150 - $170 / hour
Seniority
Senior
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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