State Licensed Physician Reviewer

A company is looking for a Physician Reviewer.

Key Responsibilities

Evaluate clinical service requests made by members and providers

Use clinical judgment to adjudicate requests based on organizational criteria

Participate in continuous quality improvement activities and policy development

Required Qualifications

Board Certified (ABMS) M.D. or D.O. with an unrestricted and active medical license

Minimum of 5 years of clinical experience, including inpatient experience

Understanding of managed care and proficiency in computer file review

New Mexico licensure preferred but not required