Physician

Medical Review Professional Physician Remote Description: Diversified Systems is searching for Medical Review Professional Physicians to perform reviews of external medical review requests and prior authorization requests involving medical necessity, resource utilization, standards of care, quality of care, and related clinical issues. The selected physicians will provide reasoned clinical opinions and respond to specific medical questions presented as part of the review process. Physician reviewers may receive expedited External Medical Review (EMR) requests requiring turnaround times of less than three business days. Responsibilities: Perform reviews of external medical review requests. Perform reviews of prior authorization requests. Evaluate issues related to medical necessity, resource utilization, standards of care, and overall quality of care. Provide reasoned clinical opinions and recommendations. Respond to specific clinical questions associated with review requests. Support expedited External Medical Review (EMR) requests as assigned. Requirements: Current unrestricted Ohio medical license required. Must be licensed as a Doctor of Medicine (MD), Doctor of Osteopathic Medicine (DO), or Doctor of Podiatric Medicine (DPM) in the United States with an unencumbered license required. 5+ years of experience in specialty field of medicine required. Must have actively practiced within specialty field during the past 12 months providing direct patient care required. Board certification in specialty field required. Physician must provide a copy of board certification(s). No history of sanctions or disciplinary actions required. No loss of personnel privileges or restrictions on participation required. Prior Authorization Specialty Needed: Internal Medicine. External Medical Review (EMR) Specialties Needed: Orthopedic Surgery. Physical Medicine and Rehabilitation (PM&R)Pain Medicine. Addiction Medicine. Neurology. Neurosurgery. Cardiology. Adult Psychiatry. Child Psychiatry (specialized in ABA). Oncology. Pediatrics. Ophthalmology. Desired Skills: Previous Prior Authorization review experience preferred. About Diversified Systems Founded in 1990, Diversified Systems is an award-winning Technology Services corporation providing all levels of IT project consulting services nationwide. DSI is headquartered in Columbus, Ohio with regional offices in the American Midwest and East Coast. We offer our consultants a number of flexible and competitive compensation benefit packages. Diversified Systems is committed to the principles of equal employment. We are committed to complying with all federal, state, and local laws providing equal employment opportunities, and all other employment laws and regulations. Diversity, Equity and Inclusion DSI values authenticity and is committed to making sure our employees and partners are valued and respected. At DSI, we believe building a diverse culture is important because we know when people work together, we can achieve better results as a team. DSI realizes that everyone comes from various backgrounds. We celebrate these differences because our employees are our greatest asset as we strive to best meet the needs of those we serve. As part of our ongoing efforts, DSI is focused on advancing equality, diversity, and inclusion by setting high standards to continually evolve our culture. This includes but is not limited to recruiting, community involvement, client delivery, and career development.