Physician Clinical Reviewer – Gastroenterology
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Job Description
Clinical Reviewer for Prime Therapeutics handling medical review of service requests. Collaborates with physicians and ensures compliance with policies and guidelines.
Responsibilities:
- Reviews cases for medical necessity
- Discusses determinations with physicians
- Provides clinical rationale for appeals
- Assists Initial Clinical Reviewers
- Ensures timely communication documentation
- Participates in ongoing training
- Assists with research related to Utilization Management
Requirements:
- DO, MBBS, or MD required
- 5+ years of experience in clinical review
- Eligible to work in the United States without the need for work visa
Benefits:
- Health insurance
- Retirement plans
- Paid time off
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