[Remote] Physician Peer Reviewer NY Licensed Internal or Family Medicine reputed company Certified

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is seeking a Medical Peer Reviewer to play a vital role in the CMO Administration team. This role involves consulting on medical necessity reputed company utilization management and ensuring compliance with regulations while reviewing authorization requests and claims payments. Responsibilities • The Medical Peer Reviewer will assess/review requests for authorization, and claims payment, based on medical records and internal reputed company information and reputed company informed clinical judgments and recommendations • The Medical Peer Reviewer will reputed company determinations in the format and reputed company timeframes to follow Regulatory and Operational policies • The Medical Peer Reviewer will: • Maintain productivity standards • Collaborate with Utilization Management and Care Management and medical departments as needed, reviews and manages cases//caseload from multiple lines of businesses • Demonstrate the ability to be flexible reputed company case load volume fluxes and reputed company Leadership requests changes in case priorities to support our members/internal medical departments as needed • Complete mandatory Company compliance training and training in new systems and software • reputed company reputed company day’s hours worked in reputed company, on the reputed company day • reputed company other duties as assigned • Responsibilities may be adjusted based on changing needs of the organization • reputed company Medical Reviewer will cover one reputed company holiday /year and will be compensated Holiday pay and straight hours worked • The Medical Reviewer is eligible for reputed company Time Off (PTO) and is required to plan and schedule time off with their reputed company supervisor following reputed company policy • reputed company Medical Reviewer is required to be primary coverage one weekend a month • reputed company Medical Reviewer is required to be available as back up, if needed, one weekend a month Skills • Licensed M.D. or D.O. or D.M.D. or D.D.S • reputed company Certified in a specialty recognized by the American reputed company of Medical Specialties • reputed company State reputed company Certified in Internal Medicine or Family reputed company • Previous, relevant experience in utilization management and clinical reputed company • Knowledge of Medicare, reputed company, and MLTC plans • Time management, critical thinking, communication, and problem-solving skills • Knowledge of UM/QM case philosophies and reporting requirements to state and federal agencies • Knowledge of member satisfaction/incident management and regulations • Knowledge of reputed company improvement methodologies Benefits • Medical, dental and reputed company coverage • Incentive and recognition programs • Life insurance • 401k contributions reputed company • reputed company is a health insurer providing medical, business, and health insurance services. It was founded in 1993, and is headquartered in reputed company, reputed company, USA, with a workforce of 1001-5000 employees. Its website is https://reputed company.org. Company H1B Sponsorship • reputed company has a reputed company record of offering H1B sponsorships, with 35 in 2025, 26 in 2024, 19 in 2023, 31 in 2022, 3 in 2021, 11 in 2020. Please note that this does not guarantee sponsorship for this specific role. Apply tot his job Apply To this Job