Base: $90.87 - $154.33 ph; bonus/equity: not speci...
Fully remote
Medical necessity case review
Utilization management guidelines
Physician communication and consultation
The Physician Clinical Reviewer serves as a key member of the utilization management team providing timely medical reviews for service requests
Job Summary
The Physician Clinical Reviewer serves as a key member of the utilization management team providing timely medical reviews for service requests.
This role requires interacting with physicians to discuss determinations within regulatory timeframes while ensuring compliance with URAC and NCQA guidelines.
Prime Therapeutics offers a competitive salary range from $90.87 to $154.33 per hour for this remote position.
Matching Summary
The Physician Clinical Reviewer serves as a key member of the utilization management team providing timely medical reviews for service requests.
Salary
Base: $90.87 - $154.33 per hour; Bonus/Equity: Not specified; Benefits: Available via benefits page
Skills & Requirements
Must-have
Medical necessity case review
Utilization management guidelines
Physician communication and consultation
URAC and NCQA compliance adherence
Appeals rationale documentation
Nice-to-have
Medicare Part D experience preferred
Cost benefit analysis familiarity
Continuous quality improvement process
Inter-rater reliability training participation
Key Requirements
MD, DO, or MBBS degree with US internship and residency
Current unrestricted US medical license
Board certification by ABMS, ABOS, ABIM, or ABOIM
Minimum 1 year clinical review work experience
Eligible to work in US without visa sponsorship
Work Rights
Must be eligible to work in the United States without visa sponsorship