Determine the medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines.
Provide timely medical reviews that meet stringent quality parameters and meet appropriate turnaround times.
Document all communication and decision‑making clearly and accurately in workflow tools.
Conduct peer‑to‑peer discussions with treating providers to clarify clinical information and explain review outcome decisions.
Receive and review escalated reviews and ensure compliance with all applicable laws and regulations.
Requirements
Board certification as an MD or DO.
Active medical license in FL, NC, or AZ, or possession of an active Interstate Medical Licensure Compact (IMLC).
6+ years of clinical practice experience.
Preferred Qualifications
1+ years of utilizatio...
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