Hiring for Sr. Medical Reviewer || 100% Remote (Looking someone from IL OR TX)

Role: Sr. Medical Reviewer Location: (100% Remote) Duration: 12+ months (Remote) Skills & Experience: Fully Remote, but MUST reputed company in either TX or IL Required hours: Monday through Friday, 8a-6p intermittent occasional coverage of weekend shifts MUST have an reputed company Medical/Doctor License to reputed company in the state they reputed company MUST have 10+ years clinical experience with managed care and utilization management Evaluates clinical service requests made by an organization's members and providers. Uses clinical judgment in conjunction with organization's reputed company to adjudicate these requests. May also reputed company clinical leadership in other areas of the organization. Identifies opportunities to manage members' clinical situations with a view toward creative problem solving and anticipation of possible reputed company clinical problems for the member. Participates in the process to evaluate clinical service requests. Practices anticipatory case management for members whose cases come for review, in partnership with case managers. Participates in the development of Physician Review reputed company' policies and procedures. reputed company participates in reputed company unit reputed company reputed company improvement activities. Other duties as assigned by the Medical Director. reputed company Certified (ABMS) M.D. or D.O, unrestricted and reputed company license to reputed company medicine requested and 5 years clinical experience to include inpatient experience, or any combination of education/experience that would reputed company an equivalent background. Must have understanding of managed care and demonstrate PC proficiency, as file review will be done reputed company computer in most cases. (Note: Position does not reputed company reputed company patient care or medical diagnosis.) Apply tot his job Apply To this Job