Physician Clinical Reviewer-Pediatric Oncologist- (Remote)

Key Responsibilities

This role involves providing timely medical review for service requests that do not initially meet medical necessity guidelines, requiring interaction with physicians and providers to discuss determinations and provide clinical rationale for appeals. The reviewer also assists in maintaining consistency by utilizing clinical review guidelines and participating in training and research activities related to utilization management.

Requirements

Candidates must have 5 or more years of clinical experience and hold a DO, MBBS, or MD degree, with eligibility to work in the United States without sponsorship required. Responsibilities include reviewing complex cases, communicating determinations within regulatory timeframes, and ensuring accurate documentation of all provider communications.

Qualifications

Education

Doctoral or professional degree (postgraduate degree)

Experience

5+ years of experience

Key Skills