New Jersey Licensed Family Practice Physician

Job Summary

A company is looking for a Family Practice Telecommute Medical Reviewer.

Key Responsibilities

• Reviews medical files and provides recommendations for utilization review and medical necessity
• Maintains proper credentialing and state licenses while returning cases with clear rationales
• Telephonically contacts providers and discusses appeal processes and quality assurance issues

Required Qualifications

• Board certified MD or DO with an understanding of managed care and utilization of services
• Current, unrestricted clinical license(s) or a process ensuring compliance with restrictions
• Active medical practice required for performing appeals
• Post-graduate experience in direct patient care
• Board certification by relevant medical specialties is required