Physician Reviewer (Remote, 24‑Month Contract)

About the role

This remote Physician Reviewer position involves evaluating clinical service requests submitted by members and providers. The role uses clinical judgment alongside organizational criteria to adjudicate requests and may provide clinical leadership across the organization.

Key responsibilities

• Evaluate and adjudicate clinical service requests using established criteria.
• Identify opportunities for proactive clinical problem solving and future risk mitigation.
• Participate in the Physician Review Unit’s appeal process for denied services.
• Contribute to the development and revision of policies and procedures for the review unit.
• Engage in continuous quality‑improvement activities within the unit.
• Perform other duties as assigned by the Medical Director.

Required profile

• Board‑Certified (ABMS) M.D. or D.O. with an unrestricted, active medical license.
• Minimum five years of clinical experience, including inpatient care, or an equivalent combination of education and experience.
• Understanding of managed‑care concepts and processes.
• Proficiency with computer‑based file review and documentation.

Required skills