Physician Reviewer

The Physician Reviewer will primarily be responsible for Clinical Appropriateness Reviews. Essential job duties include providing clinical appropriateness reviews, establishing 2-3 cases a day for each market covered (up to 6 markets), ensuring attendance on all health plan and local calls, and participating in weekly Primary Care Provider (PCP) and Skilled Nursing Facility (SNF) meetings. They will also advise other physician reviewers and participate in Process and Quality improvement in our developing area of Delegated Utilization Management. Must have excellent analytical and deductive reasoning skills and good judgement.