Position:            Physician Reviewer
Reports to:        Corporate Medical Director
Location:           Remote/Telecommute

Summary

MCMC is recruiting physician reviewers to join our peer review panel. This is a remote, consultant position.  MCMC provides independent medical reviews of the highest possible quality to health plans, health insurers, self-insured employers, and anyone else who wants an independent, objective opinion about the facts of a medical care case. We review cases in all domains of medicine, at all levels of technology, for all age groups.

Responsibilities

  • Evaluate clinical requests for medical necessity and medical appropriateness, experimental or investigational treatment or both, from various referral sources
  • Utilizes clinical judgment in conjunction with relevant health plan criteria or guidelines to substantiate service requests
  • Contacts the attending provider and remains professional and objective during this interaction
  • Supports every recommendation with a clear, precise rationale based on the clinical facts available for review
  • Completes all reviews within the specified turn-around-time
  • Completes all reviews according to MCMC operational directions and client specific instructions, in a clear and comprehensive fashion
  • Consults collaboratively with clinical and non-clinical team members
  • Adheres to URAC, NCQA, ERISA, and other applicable regulatory and legislative requirements and standards
  • Other duties as assigned

Qualifications

    Education

  • Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO)

    Skills

  • Knowledge of current practice standards
  • Strong oral communication and interpersonal skills
  • Strong computer skills with the ability to learn new applications
  • Strong analytical skills
  • Ability to work independently and with a team
  • Ability to work in a dynamic, fast-paced environment

    Experience

  • 5 or more years post graduate experience in direct patient care

    Licenses & Certifications

  • Must have an active, unrestricted U.S. medical license
  • Must be Board Certified in Orthopaedic Surgery by the ABOS or AOBOS


If interested, please send an email to [email protected] or call 866-823-4019.