Physician Clinical Reviewer – Orthopedics
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Job Description
Physician Clinical Reviewer responsible for reviewing clinical determinations and liaising with healthcare providers. Engages in quality assurance and compliance with medical guidelines and regulations in a remote capacity.
Responsibilities:
- Reviews cases in which clinical determinations cannot be made by the Initial Clinical Reviewer
- Discusses determinations with requesting physicians or ordering providers, when available, within the regulatory time frame of the request by phone or fax
- Provides clinical rationale for standard and expedited appeals
- Ensures documentation of all communications with medical office staff and/or physician/provider is recorded in a timely and accurate manner
Requirements:
- 5+ years of experience in clinical review
- DO, MBBS, or MD degree
- Must be eligible to work in the United States without the need for work visa or residency sponsorship
Benefits:
- Health insurance
- 401(k) matching
- Paid time off
- Flexible work arrangements
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