Physician Peer Reviewer (MT, ID, WA, OR)

A company is looking for a Physician Peer Reviewer. Key Responsibilities Interface with various departments including Care Management and Clinical teams Review and manage appeals, and provide expertise in claims adjudication and care management issues Conduct utilization review activities and assist with provider credentialing and Pharmacy and Therapeutics Committee functions Required Qualifications Doctor of Medicine (MD or DO) with an unrestricted license in MT, ID, WA, or OR Minimum of three years of experience as an Assistant Medical Director or Medical Officer in a health insurance plan Board certification recognized by the American Board of Medical Specialties (ABMS) is preferred Comprehensive knowledge of healthcare business principles and quality improvement methodologies Basic computer skills and the ability to read and comprehend Spanish is a plus

Mar 25, 2025 - 17:10

A company is looking for a Physician Peer Reviewer. Key Responsibilities Interface with various departments including Care Management and Clinical teams Review and manage appeals, and provide expertise in claims adjudication and care management issues Conduct utilization review activities and assist with provider credentialing and Pharmacy and Therapeutics Committee functions Required Qualifications Doctor of Medicine (MD or DO) with an unrestricted license in MT, ID, WA, or OR Minimum of three years of experience as an Assistant Medical Director or Medical Officer in a health insurance plan Board certification recognized by the American Board of Medical Specialties (ABMS) is preferred Comprehensive knowledge of healthcare business principles and quality improvement methodologies Basic computer skills and the ability to read and comprehend Spanish is a plus