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 Interacts with healthcare providers regarding claims 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 to ensure compliance with restrictions Board certification by the American Board of Medical Specialties or American Board of Osteopathic Specialties Active medical practice experience to perform appeals Post-graduate experience in direct patient care

Apr 9, 2025 - 18:32

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 Interacts with healthcare providers regarding claims 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 to ensure compliance with restrictions Board certification by the American Board of Medical Specialties or American Board of Osteopathic Specialties Active medical practice experience to perform appeals Post-graduate experience in direct patient care