Texas Licensed Medical Review Physician

A company is looking for a Telecommute Medical Review Stream Physician. Key Responsibilities Reviews medical files and provides recommendations for utilization review, medical necessity, and appropriateness of care Maintains proper credentialing and state licenses while returning cases with clear rationales Telephonically contacts providers and interacts with healthcare professionals regarding claims and appeals Required Qualifications, Training, and Education 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 state restrictions Active medical practice is required for performing appeals Post-graduate experience in direct patient care Board certification by American Board of Medical Specialties or American Board of Osteopathic Specialties is required

Mar 12, 2025 - 04:07

A company is looking for a Telecommute Medical Review Stream Physician. Key Responsibilities Reviews medical files and provides recommendations for utilization review, medical necessity, and appropriateness of care Maintains proper credentialing and state licenses while returning cases with clear rationales Telephonically contacts providers and interacts with healthcare professionals regarding claims and appeals Required Qualifications, Training, and Education 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 state restrictions Active medical practice is required for performing appeals Post-graduate experience in direct patient care Board certification by American Board of Medical Specialties or American Board of Osteopathic Specialties is required