Licensed Physician Reviewer

A company is looking for a Physician Reviewer - Utilization Review.

Key Responsibilities

Conduct timely medical reviews to ensure compliance with quality parameters

Make clinical determinations based on evidence-based criteria and document decisions accurately

Engage in peer-to-peer discussions with providers to clarify clinical information and review outcomes

Required Qualifications

Board certification

MD or DO with a current unrestricted license to practice medicine

6+ years of clinical practice experience

1+ years of utilization review experience in a managed care plan