Job Summary
A company is looking for a Remote Behavioral Health Physician Reviewer.
Key Responsibilities
- Review medical records and determine service authorization based on clinical guidelines and health plan criteria
- Conduct peer-to-peer calls with providers to gather additional clinical information
- Collaborate with internal teams and adhere to URAC standards and regulatory compliance
Required Qualifications
- MD or DO, Board Certified in General Psychiatry and either Child & Adolescent Psychiatry or Addiction Medicine
- 5+ years of clinical experience, including residency
- Recent direct patient care experience within the last 6 months
- Clean medical license and background from any U.S. state
- Above-average computer skills and comfort with multiple systems
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