Physician Clinical Reviewer – Orthopedics
Job Description:
• Reviews cases in which clinical determinations cannot be made by the Initial Clinical Reviewer
• Discusses determinations with requesting physicians or ordering providers, when available, within the regulatory time frame of the request by phone or fax
• Provides clinical rationale for standard and expedited appeals
• Ensures documentation of all communications with medical office staff and/or physician/provider is recorded in a timely and accurate manner
Requirements:
• 5+ years of experience in clinical review
• DO, MBBS, or MD degree
• Must be eligible to work in the United States without the need for work visa or residency sponsorship
Benefits:
• Health insurance
• 401(k) matching
• Paid time off
• Flexible work arrangements
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