[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 and improvement services. 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 patient reputed company.

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

• An annual stipend gives you the freedom to enhance your workspace with reputed company that suit your needs.
• 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

reputed company