Physician Reviewer (Part Time)

Responsibilities

• Carry out medical necessity reviews for cases that might not meet established criteria and issue adverse determinations when necessary.
• Evaluate requests across post-acute care services in line with clinical and regulatory standards.
• Meet or exceed Service Level Agreements (SLA) and performance guarantees required by health plan clients.
• Apply sound clinical judgment and maintain integrity in all determinations and interactions.
• Collaborate effectively with internal and external stakeholders, including providers and physicians.
• Perform other duties as assigned.

Qualifications

• MD or DO with an active, unrestricted medical license (in states aligned with CareCentrix client payer requirements).
• Current and unexpired board certification in a relevant specialty.
• Minimum 3+ years of utilization management (UM) experience.
• Minimum 3+ years of clinical practice experience, including inpatient care.
• Experience using evidence-based clinical guidelines (e.g., Milliman/InterQual), as well as CMS and state-specific regulatory criteria, preferred.

Pay

$150 to $170 per hour

Schedule

Consistent weekday schedule, between 8:00 a.m. and 6:00 p.m. EST, with flexibility to work additional hours as needed to meet business demands (including evenings, weekends, and holidays).

About the Role

Conduct utilization reviews to determine medical necessity across various lines of business, including Post-Acute Care, Home Health, Durable Medical Equipment (DME), Home Infusion Therapy, and Sleep services.

Benefits

N/A

Schedule

Consistent weekday schedule, between 8:00 a.m. and 6:00 p.m. EST, with flexibility to work additional hours as needed to meet business demands (including evenings, weekends, and holidays).

Skills

N/A

Employment Selection

We are an equal opportunity employer.