Physician Clinical Reviewer – Allergy/Immunology
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Job Description
Physician Clinical Reviewer evaluating clinical cases while ensuring medical necessity guidelines compliance at Prime Therapeutics. Collaborates with physicians to resolve determinations and assists with appeals.
Responsibilities:
- Reviews cases for medical necessity guidelines
- Discusses determinations with physicians when available
- Provides clinical rationale for appeals
- Ensures documentation of communications is accurate and timely
- Assists Initial Clinical Reviewers as needed
Requirements:
- 5+ years of experience in clinical review
- DO, MBBS, or MD degree required
- Must be eligible to work in the United States without the need for work visa or residency sponsorship
Benefits:
- Health insurance
- Retirement plans
- Paid time off
- Flexible working arrangements
- Professional development opportunities
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