Physician Reviewer for managed care. Conduct medical record reviews, prior authorization, and appeals. Florida license required.
Join Independent Living Systems as a Physician Reviewer – Florida, Managed Care in Florida.
Key Responsibilities
- Demonstrates commitment to Our Mission and models ILS Experience Standards of Excellence.
- Review requests for prior authorizations, inpatient and concurrent review, outpatient and procedural requests, and long term care services by analyzing medical records, clinical data, and treatment plans to assess the necessity and appropriateness of healthcare services.
- Apply established clinical guidelines and criteria to evaluate patient care and support utilization management decisions.
- Communicate findings and recommendations clearly to healthcare providers, utilization nurses and case managers.
Requirements
- Medical degree (MD or DO) from an accredited institution.
- Active and unrestricted Florida medical license.
- Minimum of 3 years clinical experience in a managed care setting.
- Strong knowledge of clinical guidelines, and healthcare regulations.
Work Schedule
- No explicit call, weekend, or night shift information provided.
Apply to join Independent Living Systems as a Physician Reviewer – Florida, Managed Care.
Qualifications
- Education
- Doctoral or professional degree (postgraduate degree)
- Experience
- 2+ years of experience
Key Skills
Medical Record ReviewUtilization ManagementClinical Documentation EvaluationMedical Necessity AssessmentPeer-to-Peer ReviewHIPAA ComplianceElectronic Medical RecordsMedical AuditingHealthcare Quality AssuranceManaged CareClinical Guidelines ApplicationGrievances and Appeals Review
