Physician Clinical Reviewer – Ophthalmology
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Job Description
Key member reviewing service requests that do not meet medical necessity guidelines. Interacting with healthcare professionals to ensure compliance and proper documentation in ophthalmology.
Responsibilities:
- Review service requests for medical necessity
- Interact with physicians and other healthcare professionals
- Ensure compliance with URAC and NCQA guidelines
- Document communications with medical staff
- Participate in ongoing training and testing
Requirements:
- Education Level DO, MBBS, MD
- 5+ years of clinical experience
- 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 work arrangements
- Professional development
- Bonuses
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