Medical Reviewer

• Provide independent medical documentation review and functional capacity analysis to support RA determinations under the Rehabilitation Act of 1973 and aligned with EEOC.
• Conduct independent review of medical documentation.
• Analyze diagnosis and sufficiency, and functional limitations (not just the condition). Alignment with essential job functions.
• Provide written clinical opinions including whether impairment substantially limits major life activities, functional restrictions and duration, consistency of documentation, and need for clarification or additional medical information with recommended follow-up questions.
• Advising on medical plausibility of requested accommodations.
• HIPPAA aligned confidentiality.
• Defensible, audit ready documentation.

Medical Reviewer, Reasonable Accommodations Program – MD or DO Required

• Conduct prospective, concurrent, and retrospective utilization management reviews
• Apply clinical review criteria, organizational policies, guidelines, and screening tools (InterQual)
• Consult with physician/practitioner consultants when services do not meet medical necessity criteria
• Collaborate with internal teams and refer cases for additional review or escalation as appropriate
• Respond to provider, customer, and stakeholder questions regarding determinations and processes

See all jobs on JobTailor

Medical Reviewer, Reasonable Accommodations Program – MD or DO Required

Clinical Reviewer