Physician Reviewer (Part Time)

<h2>Overview</h2> <p>As a Part-Time Physician Reviewer, you will conduct utilization reviews to determine medical necessity across our different lines of business, including Post-Acute Care, Home Health, Durable Medical Equipment (DME), Home Infusion Therapy, Sleep services.</p> <p>In this role, you will collaborate, as needed, with internal staff, providers, and ordering physicians to support appropriate, evidence-based care decisions.</p> <p><strong>Position Details:</strong>• <strong>Title:</strong> Physician Reviewer (Part-Time, Permanent)• <strong>Pay:</strong> $150 to $170 per hour•<strong> Hours:</strong> 25 hours per week• <strong>Schedule:</strong> Consistent weekday schedule, between 8:00 a.m. and 6:00 p.m. EST, with flexibility to work additional hours as needed to meet business demands (including evenings, weekends, and holidays)</p> <h2>Responsibilities</h2> <ul> <li>Conduct medical necessity reviews for cases that may not meet established criteria and issue adverse determinations when appropriate</li> <li>Evaluate requests across post-acute care services in alignment with clinical and regulatory standards</li> <li>Meet or exceed Service Level Agreements (SLA) and performance guarantees required by health plan clients</li> <li>Apply sound clinical judgment and maintain integrity in all determinations and interactions</li> <li>Collaborate effectively with internal and external stakeholders, including providers and physicians</li> <li>Perform other duties as assigned</li> </ul> <h2>Qualifications</h2> <ul> <li>MD or DO with an active, unrestricted medical license (in states aligned with CareCentrix client payer requirements)</li> <li>Current and unexpired board certification in a relevant specialty</li> <li>Minimum 3+ years of utilization management (UM) experience</li> <li>Minimum 3+ years of clinical practice experience, including inpatient care</li> <li>Experience using evidence-based clinical guidelines (e.g., Milliman/InterQual), as well as CMS and state-specific regulatory criteria, preferred</li> </ul> <p>CareCentrix maintains a drug-free workplace</p> <p>We are an equal opportunity employer. Employment selection and related decisions are made without regard to age, race, color, national origin, religion, sex, disability, sexual orientation, gender identification, or being a qualified disabled veteran or qualified veteran of the Vietnam era or any other category protected by Federal or State law.</p> <p>CareCentrix accepts applications on an ongoing basis until a candidate is identified.</p> <p>#IDCC </p>