LA Licensed Psychiatrist - Remote Peer Reviewer

STATEMENT OF ROLE & RESPONSIBILITY

POSITION TITLE: Physician Clinical Reviewer

SCOPE OF ROLE & RESPONSIBILITIES

• Clinical review of internal and/or external review cases for medical necessity, treatment appropriateness, or administrative compliance.
• Thorough review of all submitted information, documentation of determination, clinical rationale, and citation of sources used to support decision within the specified timeframe.
• Complete Peer-to-Peer phone calls with providers when scheduled.

QUALIFICATION REQUIREMENTS

• Have current, non-restricted licensure or certification as required for clinical practice in a state of the United States.
• Have at least five (5) years full-time equivalent experience providing direct clinical care to patients;
• Have a scope of licensure or certification and professional experience that typically manages the medical condition, procedure, treatment, or issue and are clinical peers for each case under review.
• If an M.D. or D.O. has board certification by a medical specialty board approved by the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA); and if a D.P.M., has board certification by the American Board of Podiatric Surgery (ABPS) or the American Board of Podiatric Orthopedics and Primary Podiatric Medicine
• If performing External Review, must meet all of the above and have experience providing direct clinical care to patients within the past three (3) years.
• MUST be licensed in the state of Louisiana

Job Types: Part-time, Contract

Benefits:

• Flexible schedule

Work Location: Remote