Physician Clinical Reviewer – Endocrinology
Prime Therapeutics
part-time
Posted on:
Location Type: Remote
Location: United States
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Salary
💰 $91 - $154 per hour
Job Level
About the role
- Reviews cases in which clinical determinations cannot be made by the Initial Clinical Reviewer.
- Discusses determinations with requesting physicians or ordering providers, when available, within the regulatory time frame of the request by phone or fax.
- Provides clinical rationale for standard and expedited appeals.
- Provides assistance and acts as a resource to Initial Clinical Reviewers as needed to discuss cases and problems.
- Ensures documentation of all communications with medical office staff and/or physician/provider is recorded in a timely and accurate manner.
- Participates in on-going inter-rater reliability training and testing
- Assists the Medical Director and/or VP, Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines, and/or system support.
Requirements
- Doctor of Medicine (MD), Doctor of Osteopathic Medicine (DO) or international degree with successful completion of United States based internship and residency
- Current, unrestricted license to practice medicine in one or more states of the United States
- Board Certified by American Board of Medical Specialties (ABMS), American Board of Osteopathic Specialties (ABOS), American Board of Internal Medicine or American Board of Osteopathic Internal Medicine (ABIM/ABOIM)
- 1 year of work experience in clinical review
- Must be eligible to work in the United States without the need for work visa or residency sponsorship.
Benefits
- Health insurance
- Health and wellness programs
- Paid time off
- Professional development opportunities
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
clinical reviewclinical rationaleutilization managementinter-rater reliability
Soft Skills
communicationproblem-solvingresourcefulness
Certifications
Doctor of Medicine (MD)Doctor of Osteopathic Medicine (DO)American Board of Medical Specialties (ABMS)American Board of Osteopathic Specialties (ABOS)American Board of Internal Medicine (ABIM)American Board of Osteopathic Internal Medicine (ABOIM)