Medical Peer Reviewer
HealthfirstUnited States
Posted March 26, 2026
122907 - 188020 USD
Full Time
About the Company
Healthfirst believes that every New Yorker deserves access to the best available healthcare. As one of New Yorkās highest quality not-for-profit health insurers serving close to two million New Yorkers, we make this a reality for our members. Founded more than 30 years ago by the leading hospital systems in downstate New York, Healthfirst established a partnership model that enables hospitals, health systems, and physicians in our network to prioritize health outcomes over profits, placing the needs of our members and community first. Healthfirst serves members in New York City, on Long Island, and in Westchester, Rockland, Sullivan, and Orange counties, offering market-leading products to suit every life stage. Our offerings include Medicaid plans, Medicare Advantage plans, Child Health Plus plans, Essential Plans, Long-Term Care plans, and Qualified Health plans. For more information on Healthfirst, please visit healthfirst.org.
Job Description
The Medical Peer Reviewer plays a critical role in consulting on medical necessity in the context of utilization management and ensuring adherence to internal Healthfirst and external regulations.
Requirements
- Licensed M.D. or D.O. or D.M.D. or D.D.S.
- Board Certified in a specialty recognized by the American Board of Medical Specialties
- Time management, critical thinking, communication, and problem-solving skills
- Knowledge of Medicare, Medicaid, and MLTC plans
- Annual Compliance and other training as assigned
Benefits
- Medical, dental and vision coverage
- Incentive and recognition programs
- Life insurance
- 401k contributions
