Physician Clinical Reviewer – Cardiology
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Job Description
Physician Clinical Reviewer providing medical reviews for service requests at Prime Therapeutics. Engaging with physicians and participating in appeals, focusing on patient care and compliance.
Responsibilities:
- Review cases for medical necessity guidelines
- Discuss determinations with physicians
- Provide clinical rationale for appeals
- Assist Initial Clinical Reviewers in case discussions
Requirements:
- 5+ years of clinical experience
- DO, MBBS or MD required
- Must be eligible to work in the United States without the need for visa sponsorship
Benefits:
- Health insurance
- 401(k) matching
- Flexible work hours
- Paid time off
- Remote work options
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