Physician Clinical Reviewer - Psychiatry- (Remote)

Key Responsibilities

This role involves providing timely medical review for service requests that do not initially meet medical necessity guidelines, acting as a resource for staff, and participating in Behavioral Health Case Management and Utilization Management Programs. Responsibilities include conducting initial and appeal reviews, facilitating peer-to-peer discussions with providers, and supporting quality assurance reviews.

Requirements

Candidates must possess an MD or DO degree and have a minimum of 5 years of clinical experience, specifically in Psychiatry/Behavioral Health, and must be eligible to work in the United States without sponsorship. The role requires consistent use of clinical review guidelines to ensure compliance and accurate documentation of all provider communications.

Qualifications

Education

Doctoral or professional degree (postgraduate degree)

Experience

5+ years of experience

Key Skills