Physician Reviewer (Part Time)

Physician Reviewer (Part-Time)

Company: CareCentrix

Position Details:

• Title: Physician Reviewer (Part-Time, Permanent)
• Pay: $150 - $170 per hour
• Hours: 25 hours per week
• Schedule: Consistent weekday schedule, between 8:00 a.m. and 6:00 p.m. EST. Flexibility to work additional hours as needed (including evenings, weekends, and holidays) is required.

Overview:

As a Part-Time Physician Reviewer, you will conduct utilization reviews to determine medical necessity across various lines of business, including Post-Acute Care, Home Health, Durable Medical Equipment (DME), Home Infusion Therapy, and Sleep services. You will collaborate with internal staff, providers, and ordering physicians to support appropriate, evidence-based care decisions.

Responsibilities:

• Conduct medical necessity reviews for cases that may not meet established criteria and issue adverse determinations when appropriate.
• Evaluate requests for post-acute care services in alignment with clinical and regulatory standards.
• Meet or exceed Service Level Agreements (SLAs) and performance guarantees for health plan clients.
• Apply sound clinical judgment and maintain integrity in all determinations and interactions.
• Collaborate effectively with internal and external stakeholders, including providers and physicians.
• Perform other duties as assigned.

Qualifications:

• MD or DO with an active, unrestricted medical license (in states aligned with CareCentrix client payer requirements).
• Current and unexpired board certification in a relevant specialty.
• Minimum 3+ years of utilization management (UM) experience.
• Minimum 3+ years of clinical practice experience, including inpatient care.
• Experience using evidence-based clinical guidelines (e.g., Milliman/InterQual), CMS, and state-specific regulatory criteria is preferred.

CareCentrix maintains a drug-free workplace and is an equal opportunity employer. Employment decisions are made without regard to age, race, color, national origin, religion, sex, disability, sexual orientation, gender identification, or veteran status.

CareCentrix accepts applications on an ongoing basis until a candidate is identified.