Physician Reviewer Multiple Specialties - Indiana and Nevada

Responsibilities

• Review medical case files and make medical determinations.
• Analyze Federal and State laws, regulations, and applicable policy guides.
• Complete and evaluate the review process within regulatory timeframes.

Requirements

• Successful completion of a Residency or Fellowship Program.
• Current state license in a U.S. jurisdiction as a Doctor of Medicine or Doctor of Osteopathic Medicine.
• Licensed in the state where requests the review, with an unrestricted license or one that does not affect clinical judgment.
• A current board certification from the American Board of Medical Specialties or American Osteopathic Association.
• At least 5 years of post-graduate clinical experience in direct patient care.
• Experience providing direct patient care within the last 3 years, if performing external reviews.

Qualifications

Must possess a current state license in a state of the United States/recognized in the relevant jurisdictions as a Doctor of Medicine or Doctor of Osteopathic Medicine and if required by contract, licensed in the state in which requests the review. License is unrestricted and if there is a restriction that is allowed by a relevant jurisdiction, according to the medical director or clinical director, it is of the type that does not affect the health professional’s ability to fulfill the roles and responsibilities of a reviewer. License is of the type and scope that permits applying clinical judgement in consideration of an individual member's clinical needs to render a decision. For either a Doctor of Medicine or Doctor of Osteopathic Medicine, possess the same license or certification as the ordering practitioner.

Skills

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Benefits

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Pay

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Schedule

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