Physician Clinical Reviewer – Rheumatology
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Job Description
Physician Clinical Reviewer reviewing service requests for medical necessity at Prime Therapeutics. Engaging with physicians and health plan members to ensure adherence to clinical guidelines.
Responsibilities:
- Provides timely medical review of service requests
- Interacts with physicians and health plan members as needed
- Reviews clinical determinations that cannot be made initially
- Provides clinical rationale for appeals and ensures proper documentation
Requirements:
- DO, MBBS, or MD degree required
- 5+ years of clinical 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
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