Mindlance
Job Description
Job Title : Physician Reviewer
Duration : 9-10 Months Assignment (Temp to hire)
Locations : Fully Remote- (WFH)
Schedule : Monday to Friday – First Shift
NOTE: Must reside in Texas. Must have Texas Medical Licensure.
Job Profile Summary
- Evaluates clinical service requests made by an organization's members and providers.
- Uses clinical judgment in conjunction with organization's criteria to adjudicate these requests.
- May also provide clinical leadership in other areas of the organization.
- Identifies opportunities to manage members' clinical situations with a view toward creative problem solving and anticipation of possible future clinical problems for the member. Participates in the process to evaluate clinical service requests.
- Practices anticipatory case management for members whose cases come for review, in partnership with case managers.
- Participates in the Physician Review Units' appeal process of service denials.
- Participates in the development of Physician Review Units' policies and procedures.
- Actively participates in all unit continuous quality improvement activities.
- Other duties as assigned by the Medical Director. Board Certified (ABMS) M.D. or D.O, unrestricted and active license to practice medicine requested and 5 years clinical experience to include inpatient experience, or any combination of education/experience that would provide an equivalent background.
- Must have understanding of managed care and demonstrate PC proficiency, as file review will be done via computer in most cases.
- (Note: Position does not provide direct patient care or medical diagnosis.)
EEO:
“Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of – Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans. ”
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