Physician Reviewer – Part Time

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $150 - $170 / hour

⏱ Part Time

🟡 Mid-level

🟠 Senior

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CareCentrix

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1996

⚕️ Healthcare Insurance

💊 Pharmaceuticals

💰 Private Equity Round on 2011-09

Healthcare Insurance • Healthcare • Pharmaceuticals

CareCentrix is a healthcare company that simplifies care coordination and home benefit management, enabling health at home for members. By focusing on personalized care and utilizing their proprietary HomeBridge platform, they identify and engage members transitioning from hospital to home, ensuring timely delivery of appropriate services. CareCentrix's whole-person approach aims to improve outcomes, lower costs, and enhance both member and provider satisfaction through a high-quality provider network and data-driven analytics.

📋 Description

• Conduct medical necessity reviews for cases that may not meet established criteria and issue adverse determinations when appropriate • Evaluate requests across post-acute care services in alignment with clinical and regulatory standards • Meet or exceed Service Level Agreements (SLA) and performance guarantees required by health plan clients • Apply sound clinical judgment and maintain integrity in all determinations and interactions • Collaborate effectively with internal and external stakeholders, including providers and physicians • Perform other duties as assigned

🎯 Requirements

• MD or DO with an active, unrestricted medical license (in states aligned with CareCentrix client payer requirements) • Current and unexpired board certification in a relevant specialty • Minimum 3+ years of utilization management (UM) experience • Minimum 3+ years of clinical practice experience, including inpatient care • Experience using evidence-based clinical guidelines (e.g., Milliman/InterQual), as well as CMS and state-specific regulatory criteria, preferred