Physician Reviewer (Part-Time)

About the role

The Part‑Time Physician Reviewer will perform utilization reviews to assess medical necessity across multiple lines of business, including post‑acute care, home health, DME, home infusion therapy, and sleep services. This role supports evidence‑based care decisions by collaborating with internal teams, providers, and ordering physicians.

Key responsibilities

• Conduct medical necessity reviews and issue adverse determinations when criteria are not met.
• Evaluate post‑acute care requests in line with clinical and regulatory standards.
• Meet or exceed Service Level Agreements and performance guarantees for health‑plan clients.
• Apply sound clinical judgment while maintaining integrity in all determinations.
• Collaborate with internal and external stakeholders, including providers and physicians.
• Perform additional duties as assigned.

Required profile

• MD or DO with an active, unrestricted medical license in states aligned with client payer requirements.
• Current, unexpired board certification in a relevant specialty.
• Minimum 3 + years of utilization management experience.
• Minimum 3 + years of clinical practice experience, including inpatient care.

Required skills

• Utilization Management
• Evidence‑based clinical guidelines (e.g., Milliman/InterQual)
• CMS and state‑specific regulatory criteria

What we offer

• Hourly compensation ranging from $150 to $170.
• Consistent weekday schedule (25 hours/week) with flexibility for evenings, weekends, and holidays.
• Permanent part‑time employment.