Physician Reviewer Job at Careers Integrated Resources Inc, Richardson, TX

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  • Careers Integrated Resources Inc
  • Richardson, TX

Job Description

Job Title: Physician Reviewer
Job Location: Richardson, TX
Job Duration: 24 Months (possibility of extension)

Schedule is M-F, but may need to work 3-4 weekends per year remote, but must reside within one of our plan states - TX/OK/NM/IL/MT/TN
Job Responsibilities:

  • Evaluates clinical service requests made by an organization's members and providers.
  • Uses clinical judgment in conjunction with organization's criteria to adjudicate these requests.
  • May also provide clinical leadership in other areas of the organization.
  • Identifies opportunities to manage members' clinical situations with a view toward creative problem solving and anticipation of possible future clinical problems for the member.
  • in the process to evaluate clinical service requests.
  • Practices anticipatory case management for members whose cases come for review, in partnership with case managers.
  • Participates in the Physician Review Units' appeal process of service denials.
  • Participates in the development of Physician Review Units' policies and procedures.
  • Actively participates in all unit continuous quality improvement activities.
  • Other duties as assigned by the Medical Director.
Education & Experience Requirements:
  • Board Certified (ABMS) M.D. or D.O, unrestricted and active license to practice medicine requested and 5 years clinical experience to include inpatient experience, or any combination of education/experience that would provide an equivalent background.
  • Must have understanding of managed care and demonstrate PC proficiency, as file review will be done via computer in most cases.
Required Qualification(s):
  • Board Certification in a Medical Specialty, active medical license.
  • TX and NM license within 6 months.
Specialties:
  • Orthopedics.
  • Genetics.
  • PMR.
  • Allergy Immunology.
  • Rheumatology.
  • plastic surgery.
  • transplant.
  • Heme Oncology.
Note:
  • (Note: Position does not provide direct patient care or medical diagnosis.).

Job Tags

Weekend work

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