Physician Reviewer (Part Time)

Physician Reviewer (Part-Time)

Company: CareCentrix Location: Remote (USA) Job Type: Permanent Salary: $150 - $170 per hour

CareCentrix is seeking a dedicated Physician Reviewer to join our team on a part-time, permanent basis. This remote role offers a consistent weekday schedule with flexibility to accommodate business needs.

About the Role

As a Physician Reviewer, you will play a crucial role in ensuring appropriate, evidence-based care decisions. You will conduct utilization reviews to determine medical necessity across various lines of business, including Post-Acute Care, Home Health, Durable Medical Equipment (DME), Home Infusion Therapy, and Sleep services. You will collaborate with internal staff, providers, and ordering physicians to support these critical decisions.

Key Responsibilities

• Conduct utilization reviews to determine medical necessity for cases that may not meet established criteria.
• Issue adverse determinations when appropriate, based on thorough evaluation.
• Evaluate requests for post-acute care services in alignment with clinical and regulatory standards.
• Meet or exceed Service Level Agreements (SLA) and performance guarantees required by health plan clients.
• Apply sound clinical judgment and maintain integrity in all determinations and interactions.
• Collaborate effectively with internal and external stakeholders, including providers and physicians.
• Perform other duties as assigned.

Requirements

• Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO) degree.
• Active, unrestricted medical license in states aligned with CareCentrix client payer requirements.
• Current and unexpired board certification in a relevant specialty.
• Minimum of 3 years of experience in utilization management.
• Minimum of 3 years of clinical practice experience, including inpatient care.
• Experience using evidence-based clinical guidelines (e.g., Milliman/InterQual), as well as CMS and state-specific regulatory criteria, is preferred.

What We Offer

• Competitive Pay: $150 to $170 per hour.
• Flexible Schedule: Approximately 25 hours per week with a consistent weekday schedule between 8:00 a.m. and 6:00 p.m. EST. Flexibility to work additional hours as needed, including evenings, weekends, and holidays.
• Remote Work: Opportunity to work from home.
• Meaningful Work: Contribute to ensuring patients receive appropriate, evidence-based care.