Peer Reviewer – Pediatric Gastroenterology Physician

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iMPROve Health

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 1984

🏥 Healthcare

⚕️ Healthcare Insurance

💼 Consulting

Healthcare • Healthcare Insurance • Consulting

iMPROve Health is a national, fully-remote organization that specializes in healthcare quality improvement and review services. For about 40 years it has provided independent medical review, utilization review, Medicare and Medicaid program support, research methodologies, data analysis, outreach strategies, and dispute resolution (including Independent Dispute Resolution under the No Surprises Act). The organization is URAC-accredited for more than 20 years, is a certified independent dispute resolution entity, and delivers QI solutions, peer review, and related consulting services to healthcare stakeholders across multiple states.

📋 Description

• Conduct objective, evidence-based peer reviews of clinical cases • Make final determinations regarding medical necessity and quality of care • Ensure decisions are fair, unbiased, and aligned with current standards of practice • Submit reviews in a timely and professional manner using the IT systems provided • Perform independent external medical reviews remotely on an ad hoc basis

🎯 Requirements

• Must hold an unrestricted medical license in any U.S. state • Board certification required, if applicable, through ABMS, AOA, or another nationally recognized board • At least five (5) years of full-time equivalent experience providing direct clinical care to patients • Direct clinical care experience within the past three (3) years • Knowledge of the issue under review or current evidence-based clinical guidelines and novel treatments • Clinical expertise to manage the medical or behavioral health condition or disease under review • Must be actively engaged in direct or virtual patient care for at least 20 hours per week; administrative work does not qualify • Reliable Wi-Fi access • Proficiency with Microsoft Word • Access to a computer compatible with iMPROve Health's IT systems • Must complete the electronic credentialing application and receive organizational approval before performing a case review • Must complete a conflict of interest attestation upon credentialing and before performing a case review • Active hospital medical staff privileges may be required, as applicable • Must notify the organization of adverse changes in licensure or certification status • Cannot have current employment or affiliation with any Veterans Affairs hospital, health care system, or medical center when applying for VA-related peer reviews

🏖️ Benefits

• Make a Difference: Use your clinical knowledge to improve the quality of care patients receive • Professional Recognition: Join a network of highly respected experts in your specialty • Competitive Compensation: Receive fair pay for your time and expertise • Protect Standards of Care: Help uphold the integrity of your profession • Work Remotely: Review cases from the convenience of your home or office