Physician Reviewer Multiple Specialties - TEXAS and NEW MEXICO

Responsibilities

• Review medical case files and make medical determinations.
• Review and analyze Federal and State laws, regulations, and applicable policy guides.
• Complete and evaluate the review process in a regulatory timeframe.

Requirements

• Successful completion of a Residency or Fellowship Program.
• 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.
• Licensed in the state in which requests the review, with an unrestricted license or a restricted one that does not affect the ability to fulfill the roles and responsibilities of a reviewer.
• Licenses must be 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.
• A current board certification issued by 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 past 3 years, if performing external reviews.