Physician Reviewer

BCBSMA

Hingham, Massachusetts, USA
Base: $230,850.00 - $282,150.00; bonus/equity: eli...
Hybrid
Evaluate clinical service requests
Apply bcbs criteria and guidelines
Manage and optimize clinical situations
The Physician Reviewer is responsible for evaluating pre & post-service clinical service requests made by BCBSMA members and providers

Job Summary

  • The Physician Reviewer is responsible for evaluating pre & post-service clinical service requests made by BCBSMA members and providers.
  • The physician reviewer will exercise sound clinical judgment in looking for opportunities to manage and optimize members’ clinical situations and health outcomes, with a view toward creative problem solving and in anticipation of possible future clinical problems for the member.
  • We offer comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being benefits to eligible employees.

Matching Summary

The Physician Reviewer is responsible for evaluating pre & post-service clinical service requests made by BCBSMA members and providers.

Salary

Base: $230,850.00 - $282,150.00; Bonus/Equity: Eligible for variable pay; Benefits: Comprehensive package of benefits

Skills & Requirements

Must-have

  • Evaluate clinical service requests
  • Apply BCBS Criteria and guidelines
  • Manage and optimize clinical situations
  • Peer-to-peer outreach
  • Document coverage decisions

Nice-to-have

  • Creative problem solving
  • Anticipatory case management
  • Positive work environment
  • Continuous quality improvement

Key Requirements

  • MD or DO degree with active specialty board certification
  • Active unrestricted license to practice medicine in Massachusetts
  • Experience in Utilization Management
  • Experience with basic computer programs

Work Rights

Not specified

Tailored Resume

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