Physician Clinical Reviewer - Cardiology- (Remote)

Key Responsibilities

This role involves providing timely medical review of service requests that do not initially meet medical necessity guidelines, often interacting with requesting physicians by phone or fax within regulatory timeframes. Responsibilities include discussing determinations, providing clinical rationale for appeals, and ensuring consistency using medical review guidelines.

Requirements

Candidates must have 5+ years of clinical experience and hold an MD, DO, or MBBS degree, requiring eligibility to work in the United States without sponsorship. The role demands constant computer operation, communication, and the ability to remain stationary for 50% of the time.

Qualifications

Education

Doctoral or professional degree (postgraduate degree)

Experience

5+ years of experience

Key Skills