Physician Reviewer (Part Time)

Job Overview

Overview As a Part-Time Physician Reviewer, you will conduct utilization reviews to determine medical necessity across our different lines of business, including Post-Acute Care, Home Health, Durable Medical Equipment (DME), Home Infusion Therapy, Sleep services.

In this role, you will collaborate, as needed, with internal staff, providers, and ordering physicians to support appropriate, evidence-based care decisions.

Job Description

Position Details: • Title: Physician Reviewer (Part-Time, Permanent)• Pay: $150 to $170 per hour• Hours: 25 hours per week• Schedule: Consistent weekday schedule, between 8:00 a. m. and 6:00 p. m.

EST, with flexibility to work additional hours as needed to meet business demands (including evenings, weekends, and holidays) Responsibilities 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 Qualifications 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 CareCentrix maintains a drug-free workplace We are an equal opportunity employer.

Employment selection and related decisions are made without regard to age, race, color, national origin, religion, sex, disability, sexual orientation, gender identification, or being a qualified disabled veteran or qualified veteran of the Vietnam era or any other category protected by Federal or State law.

CareCentrix accepts applications on an ongoing basis until a candidate is identified. #IDCC

Key Responsibilities

• Overview As a Part-Time Physician Reviewer, you will conduct utilization reviews to determine medical necessity across our different lines of business, including Post-Acute Care, Home Health, Durable Medical Equipment (DME), Home Infusion Therapy, Sleep services.
• In this role, you will collaborate, as needed, with internal staff, providers, and ordering physicians to support appropriate, evidence-based care decisions.
• EST, with flexibility to work additional hours as needed to meet business demands (including evenings, weekends, and holidays) Responsibilities 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 Qualifications 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 CareCentrix maintains a drug-free workplace We are an equal opportunity employer.

Required Skills and Qualifications

• EST, with flexibility to work additional hours as needed to meet business demands (including evenings, weekends, and holidays) Responsibilities 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 Qualifications 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 CareCentrix maintains a drug-free workplace We are an equal opportunity employer.

Work Location and Schedule

This role is listed as Remote USA with location information shown as Remote USA. The employment type is Full Time.

About the Company

CareCentrix is the organization connected with this listing. USA Jobs Today displays this opportunity for job discovery only, so applicants should verify company details, application instructions, and eligibility on the official employer website.