Job Description

• Location: Chicago, Illinois
• Type: Contract
• Job #101289

Job Title : Physician Review
Location: Remote
Job Type: Contract
Expected hours per week (must include "per week"):
40 hours per week
Schedule (include days, hours, onsite/hybrid or remote):
Monday - Friday, Remote
Pay Range (must include "per hour"):
$112 per hour
Job Description:

• Primary Function: Evaluate clinical service requests from members and providers using clinical judgment and organizational criteria.
• Additional Responsibilities:
  • Provide clinical leadership in other organizational areas.
  • Identify opportunities for proactive case management and creative problem-solving.
  • Collaborate with case managers for anticipatory case management.
  • Participate in:
    • Physician Review Unit's appeal process for service denials.
    • Development of policies and procedures for the Physician Review Unit.
    • Continuous quality improvement activities.
  • Perform other duties as assigned by the Medical Director.

Qualifications

• Education & Certification:
  • Board Certified (ABMS) M.D. or D.O.
  • Active, unrestricted license to practice medicine.
• Experience:
  • Minimum 5 years of clinical experience, including inpatient care.
  • Or equivalent combination of education and experience.
• Skills:
  • Understanding of managed care.
  • Proficiency with PC systems (file review is computer-based).
• Note: This position does not involve direct patient care or medical diagnosis.

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Job Tags

Hourly pay, Contract work, Monday to Friday,

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