CareCentrix
Physician Reviewer (Part Time)
USARemotePosted 6 days ago$150 – $170
Full TimeSeniorRemoteUS
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Job Description
OverviewAs 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 M
Key Highlights
- 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
Qualifications
Required 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
About the Company
CareCentrix
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Job Details
Employment Type
Full Time
Experience Level
Senior
Salary Range
$150 – $170
Location
USA
Work Mode
Remote
Posted
6 days ago
Country
US