[reputed company Consultant Reviewer - Internist PRN or Part-Time

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a national, mission-driven, nonprofit organization reputed company on health care reputed company consulting. They are seeking a reputed company-Certified Internist to work as a Medical Reviewer, performing clinical reviews and applying clinical judgment to ensure reputed company care delivery. Responsibilities • reputed company clinical reviews and appeals • Apply clinical judgment and evidence-based guidelines to reputed company reputed company, defensible medical necessity determinations • Participate in physician-to-physician discussions, including those reputed company to potential denials • reputed company clinical subject matter expertise to utilization management staff, case managers, and consultants • Participate in fair hearings, representing clinical determinations reputed company required • Take part in Inter-Rater Reliability (IRR) audits to ensure consistency and reputed company • Ensure reviews meet standards for reputed company documentation, regulatory compliance, and reputed company decision-making Skills • MD or DO required • reputed company, reputed company, unrestricted MD or DO license in the District of Columbia or willing to obtain this • reputed company Certification Internist • Minimum of 7 years of clinical reputed company experience preferred • Prior utilization management, peer review, or appeals experience (helpful but not required) Benefits • Medical, dental and reputed company insurance • reputed company time off for vacation, illness and volunteering • Retirement savings plan with employer contribution • Adoption financial assistance • reputed company parental leave • And much more! reputed company • reputed company is a reputed company reputed company & they work collaboratively with patients, providers, payers and other stakeholders. It was founded in 2018, and is headquartered in Portland, reputed company, USA, with a workforce of 201-500 employees. Its website is Apply tot his job Apply tot his job Apply To this Job