New Jersey Licensed Family Practice Physician
A company is looking for a Family Practice Telecommute Medical Reviewer. Key Responsibilities Reviews medical files and provides recommendations for utilization review and medical necessity Maintains proper credentialing and state licenses while returning cases with clear rationales Telephonically contacts providers and discusses appeal processes and quality assurance issues Required Qualifications Board certified MD or DO with an understanding of managed care and utilization of services Current, unrestricted clinical license(s) or a process ensuring compliance with restrictions Active medical practice required for performing appeals Post-graduate experience in direct patient care Board certification by relevant medical specialties is required
A company is looking for a Family Practice Telecommute Medical Reviewer.
Key Responsibilities
Reviews medical files and provides recommendations for utilization review and medical necessity
Maintains proper credentialing and state licenses while returning cases with clear rationales
Telephonically contacts providers and discusses appeal processes and quality assurance issues
Required Qualifications
Board certified MD or DO with an understanding of managed care and utilization of services
Current, unrestricted clinical license(s) or a process ensuring compliance with restrictions
Active medical practice required for performing appeals
Post-graduate experience in direct patient care
Board certification by relevant medical specialties is required
