Physician - Internal Medicine

Details

Client Name : PA Health & Wellness

Job Type : Travel

Position Urgency Normal

Offering Locums

Profession Physician

Specialty Internal Medicine

Job ID 16155235

Shift Details

Shift 09 : 00 AM - 05 : 00 PM

Shifts Per Week 1

scheduledHrs_1 1.0

Job Order Details

Start Date 2025-03-31

End Date 2026-11-01

Duration 83 Week(s)

Float Required No

Call Required No

Required Certifications for Onboarding AMA, DEA, NPI

Job Description Physician Reviewer - Medicaid Grievance Hearings (1099 Contract Role) Location : Remote (U.S. based) Schedule : As needed; standard business hours (9 AM - 5 PM EST) Contract Type : 1099 Independent Contractor

Position Overview We are seeking board-certified physicians to serve as Vendor Physician Reviewers for Medicaid grievance cases. In this role, you will review clinical documentation and participate in member grievance hearings, providing expert medical opinions aligned with regulatory and organizational standards.

Key Responsibilities

Grievance Review Participation

Review assigned Medicaid grievance cases within the specified timeframe. Participate in scheduled member hearings, with a minimum of 10 calendar days' notice provided. Be available for expedited cases with 24-hour notice.

Availability & Responsiveness

Acknowledge receipt of grievance review requests within 1 business day. Be available during standard business hours (9 AM - 5 PM EST). Notify PHW of any scheduling conflicts at least 5 business days in advance to avoid cancellation penalties. Communicate immediately in case of emergency or technical issues preventing participation.

Quality & Compliance

Conduct thorough, unbiased reviews of all relevant documentation (e.g., PCSP, interRAI, SPG, AR, Appeal Summary). Ensure reviews are conducted in a private, quiet environment. Adhere to PHW policies, HIPAA regulations, and applicable state / federal guidelines.

Documentation

Submit clear, comprehensive findings and recommendations within 1 business day post-review.

Communication & Collaboration

Maintain open communication with PHW staff and grievance review committees. Respond promptly to queries or requests for additional information.

Training & Development

Participate in initial and annual grievance review training sessions as required by PHW's Chief Medical Officer.

Ethics & Integrity

Disclose any potential conflicts of interest and recuse from cases where impartiality may be compromised.

Client Details

Client Type Commercial

State PA

EGA Associates, LLC provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.