Physician Reviewer

Job Overview

Remote position; must have Texas Medical Licensure.

• Evaluates clinical service requests made by an organization's members and providers.
• Uses clinical judgment in conjunction with organization's criteria to adjudicate these requests.
• Provide clinical leadership in other areas of the organization.
• Identify opportunities to manage members' clinical situations with a view toward creative problem solving and anticipation of possible future clinical problems for the member.
• Participate in the process to evaluate clinical service requests.
• Practice anticipatory case management for members whose cases come for review, in partnership with case managers.
• Participate in the development of Physician Review Units' policies and procedures.
• Actively participate in all unit continuous quality improvement activities.
• Other duties as assigned by the Medical Director.

• Board Certified (ABMS) M.D. or
  
  D.O, unrestricted and active license to practice medicine requested.
• 5 years clinical experience to include inpatient experience, or any combination of education/experience that would provide an equivalent background.
• Understanding of managed care.
• Demonstrate PC proficiency, as file review will be done via computer in most cases.
• Position does not provide direct patient care or medical diagnosis.

"Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of – Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans."