Clinician Reviewer – MD/DO, LTSS, PAS, IHSS Expertise

🔥 38 minutes ago

🇺🇸 United States – Remote

⏳ Contract/Temporary

🟡 Mid-level

🟠 Senior

👻 Ghost score 15%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

RediMinds, Inc

WebsiteLinkedInAll Job Openings

11 - 50 employees

Founded 2016

🏥 Healthcare

🤖 Artificial Intelligence

☁️ SaaS

💰 $225k Grant on 2020-05

Healthcare • Artificial Intelligence • SaaS

RediMinds is a healthcare technology company that builds and operates AI-powered platforms to support regulated medical review, arbitration, and other high‑stakes healthcare decisions. Their products automate intake, document indexing, evidence extraction, timeline and clinical summary generation, reviewer matching and credentialing, and produce audit-ready, human‑supervised determinations for workflows such as prior authorization/ePA, federal and state independent dispute resolution (IDR), state external review, Social Security disability, workers’ compensation, fraud/waste/abuse detection, and DRG review. The company emphasizes human-in-the-loop decisioning (AI prepares the work; qualified clinicians sign determinations), regulatory defensibility, and compliance with healthcare security standards (URAC, HITRUST, SOC 2, HIPAA), and publishes peer‑reviewed research.

📋 Description

• Conduct independent, evidence-based medical necessity reviews for appeals involving Personal Assistance Services • Review functional assessments, ADL/IADL scales, standardized LTSS tools, physician orders, care plans, prior authorizations, denial letters, and appellant-submitted evidence • Apply medical necessity criteria, state Medicaid and waiver program guidelines, and nationally recognized standards • Determine whether disputed PAS services are medically necessary and appropriately scoped • Render written determinations explaining clinical rationale and citing specific evidence • Address the appellant's stated basis for appeal • Address state-specific definitions, eligibility criteria, and level-of-care guidelines governing the PAS program • Identify and disclose conflicts of interest before accepting assignments • Complete assigned reviews within state-mandated and accreditation-mandated turnaround times • Maintain current knowledge of PAS regulations, clinical practices, state-specific waiver programs, and level-of-care criteria

🎯 Requirements

• Must hold an active, unrestricted medical license in one or more states as assigned • Minimum 3 years of clinical practice involving elderly, disabled, or chronically ill patients requiring or receiving long-term services and supports, personal care assistance, or in-home supportive care • Direct experience recommending, ordering, or certifying PAS-type services • Familiarity with standardized functional assessment instruments, including ADL/IADL indices, MDS-HC, InterRAI, or state-specific level-of-care tools • Working knowledge of Medicaid HCBS waivers, state PAS programs, and medical necessity criteria for in-home functional support • Experience treating populations with frailty, dementia, cognitive impairments, spinal cord injury, cerebral palsy, multiple sclerosis, stroke, or other chronic functional decline • Board certification (ABMS or AOA) in a relevant specialty, such as Internal Medicine, Geriatric Medicine, Family Medicine, Physical Medicine & Rehabilitation, or Neurology • Active, unrestricted medical licensure • Five years of active practice with direct patient care within the past year • No current or prior treating relationship with the appellant • No financial or contractual relationship with the requesting health plan, state agency, or IHSS/PAS program administrator that could reasonably affect independence • Must disclose circumstances creating actual or apparent bias before case acceptance • Prior IRO, UR, or peer reviewer experience and familiarity with URAC standards strongly preferred • Prior experience as a treating or certifying physician within a state PAS or Medicaid HCBS waiver program preferred • Experience with disability determination reviews or workers' compensation functional capacity evaluations preferred • Familiarity with InterQual and/or MCG care guidelines preferred

🏖️ Benefits

• Paid per completed case review, with rates commensurate with case complexity and turnaround urgency • Independent Contractor / Per-Case Reviewer (1099) panel appointment • Training provided for physicians new to formal review work who meet the direct clinical criteria • Equal Opportunity Employer committed to an inclusive environment

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume