Physician Clinical Reviewer - Cardiology- REMOTE
Prime TherapeuticsWashington, United States
Posted March 13, 2026
90.87 - 154.33 USD
Full Time
About the Company
Prime Therapeutics LLC (Prime) is a diversified pharmacy solutions organization. We offer innovative pharmacy benefit management, specialty and medical drug management, and state government solutions to millions of people across the country. At Prime, we’re reimagining pharmacy solutions to provide the care we’d want for our loved ones. We challenge the way it’s always been done to develop intelligently designed solutions that deliver savings, simplicity and support to help people achieve better health.
Job Description
We are seeking a Physician Clinical Reviewer to provide timely medical review of service requests and interact with physicians, leadership, and management staff to ensure consistency in the physician review process.
Requirements
- Reviews cases in which clinical determinations cannot be made by the Initial Clinical Reviewer
- Discusses determinations with requesting physicians or ordering providers
- Provides clinical rationale for standard and expedited appeals
- Utilizes medical/clinical review guidelines and parameters to assure consistency
- Participates in on-going inter-rater reliability training and testing
- Assists the Medical Director and/or VP, Medical Director in research activities/questions
Benefits
- Generous Paid Time Off
- 401k Matching
- Retirement Plan
- Visa Sponsorship
- Four Day Work Week
- Generous Parental Leave
- Tuition Reimbursement
- Relocation Assistance