Physician Clinical Reviewer - Gastroenterology- REMOTE
Prime TherapeuticsHome
Posted March 13, 2026
90000 - 154000 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
Physician Clinical Reviewer - Gastroenterology job at Prime Therapeutics: key member of utilization management team, provides timely medical review of service requests, interacts with physicians and health plan members.
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.
- Participates in on-going inter-rater reliability training and testing
- Assists the Medical Director and/or VP, Medical Director in research activities/questions related to the Utilization Management process
Benefits
- Generous Paid Time Off
- 401k Matching
- Retirement Plan
- Tuition Reimbursement
- Relocation Assistance