19027 - Physician Reviewer

Chicago, IL 60601

Posted: 02/20/2023 Industry: HCSC Other Job Number: 39534

Job Description

Physician Reviewer
AF – 19027

Location: Remote in IL, TX, OK, MT, or NM
Tenure: 26-month contract

  • Evaluates clinical service requests made by an organization's members and providers.
  • Uses clinical judgment in conjunction with organization's criteria to adjudicate these requests.
  • May also provide clinical leadership in other areas of the organization.
  • Identifies opportunities to manage members' clinical situations with a view toward creative problem solving and anticipation of possible future clinical problems for the member.
  • Participates in the process to evaluate clinical service requests.
  • Practices anticipatory case management for members whose cases come for review, in partnership with case managers.
  • Participates in the Physician Review Units' appeal process of service denials.
  • Participates in the development of Physician Review Units' policies and procedures.
  • Actively participates in all unit continuous quality improvement activities.
  • Other duties as assigned by the Medical Director.

Note: Position does not provide direct patient care or medical diagnosis.

  • Board Certified (ABMS) M.D. or D.O, unrestricted and active license to practice medicine requested
  • Minimum 5 years clinical experience to include inpatient experience, or any combination of education/experience that would provide an equivalent background.
  • Must understand managed care and demonstrate PC proficiency, as file review will be done via computer in most cases.


Job Requirements


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Alaina Fisher

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