Physician Clinical Reviewer – Pediatric Rheumatology
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Job Description
Clinical Reviewer responsible for medical review of pediatric rheumatology service requests. Supporting utilization management processes and collaboration with healthcare providers at Prime Therapeutics.
Responsibilities:
- Reviews cases in which clinical determinations cannot be made by the Initial Clinical Reviewer.
- Discusses determinations with requesting physicians or ordering providers.
- Provides clinical rationale for standard and expedited appeals.
- Assists the Medical Director and/or VP, Medical Director in research activities/questions related to the Utilization Management process.
Requirements:
- Education Level DO MBBS MD Required
- 5 years of experience 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 work arrangements
- Professional development opportunities
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