Physician Reviewer

Overview

Job Title:

Physician Reviewer

Location:

Richardson, Texas

Job Type: Contract

Expected hours per week (must include “per week”): 40 hours per week

Schedule (include days, hours, onsite/hybrid or remote):
Monday – Friday, 9-5, Remote

Pay Range (must include “per hour”): $110 per hour

About the Role

We are seeking an experienced, board-certified Physician Reviewer to evaluate clinical service requests from members and providers within our organization. This non–patient-facing role is ideal for a physician who excels in clinical judgment, problem-solving, and communicating effectively with interdisciplinary teams.

As a Physician Reviewer, you will apply clinical expertise in alignment with organizational criteria, support managed care initiatives, and contribute to the development of internal quality improvement processes. This position provides the opportunity to influence patient outcomes through thoughtful review and anticipatory case management—without direct patient care.

• Review and adjudicate clinical service requests using clinical expertise and established organizational criteria.
• Collaborate with case managers to support anticipatory case management and identify opportunities for improved care coordination.
• Provide clinical leadership and participate in the development of Physician Review Unit policies and procedures.
• Contribute to continuous quality improvement initiatives and departmental goals.
• Utilize electronic systems to complete file reviews efficiently.
• Perform additional duties as assigned by the Medical Director.

• M.D. or D.O. with active, unrestricted Texas medical license (required).
• Board Certified by an ABMS-recognized board.
• Minimum 5 years of clinical experience
  , including inpatient care; equivalent combinations of experience/education will be considered.
• Understanding of managed care principles.
• Strong computer proficiency; ability to conduct file reviews electronically.
• Excellent clinical judgment and communication skills.
• Note:
  This role does not involve direct patient care or medical diagnosis.