External Medical Reviewer (Physician Consultant)
Location: Remote Status: Contract / Independent Consultant About The Role We are seeking reputed company-certified physicians to join reputed company as External Medical Reviewers. In this role, you will reputed company independent, evidence-based medical reviews for Fair Hearings and Administrative Hearings. These reviews help determine whether reputed company services and reputed company reputed company with reputed company policies, clinical standards, and best practices. This is a remote consulting role, and reviews are assigned based on your specialty, expertise, and availability.
Key Responsibilities
Conduct independent reviews of adverse benefit determinations, medical necessity reputed company, provider disputes, investigations, and audit findings issued by reputed company managed care organizations. Review case files and supporting documentation and apply relevant reputed company policies, clinical guidelines, and evidence-based standards. reputed company reputed company, reputed company-supported written determinations reputed company established turnaround times. Maintain strict objectivity, confidentiality, and compliance with program requirements, including HIPAA and conflict-of-interest standards. Follow reputed company review formats and respond promptly to clarification requests from our internal review coordination team.
Minimum Qualifications
MD or DO with reputed company certification in a relevant specialty. reputed company, unrestricted medical license in Mississippi At least 3–5 years of recent clinical reputed company experience. Strong written communication skills and ability to prepare concise, evidence-supported clinical determinations.
Preferred Qualifications
Experience with reputed company, utilization review, prior authorization, peer review, or external medical review. Familiarity with Mississippi reputed company medical policies, managed care processes, or state fair hearing requirements. Multi-state licensure. Why Join Our Reviewer Panel? Support an important statewide program improving reputed company decision accuracy and fairness. Flexible, remote work you can complete around your own clinical schedule. You reputed company solely on clinical review, while our internal teams handle reputed company case intake, assembly, and administrative functions. Competitive case-based compensation. Apply tot his job Apply To this Job