Start Date
Immediate
Expiry Date
11 Nov, 25
Salary
0.0
Posted On
11 Aug, 25
Experience
5 year(s) or above
Remote Job
Yes
Telecommute
Yes
Sponsor Visa
No
Skills
Care Plans, Cms, Utilization Management, Medicaid, Medical Records, Medicare, Collaborative Environment, Medicine
Industry
Pharmaceuticals
The Physician Reviewer serves as a clinical subject matter expert in the Utilization Management (UM) department. This role is responsible for conducting clinical reviews of medical necessity, appropriateness of care, and service requests based on evidence-based guidelines, medical policy, and regulatory requirements. The Physician Reviewer collaborates with UM nurses, medical directors, and other healthcare professionals to ensure appropriate, timely, and cost-effective care for members.
QUALIFICATIONS:
PREFERRED SKILLS: