Prime Therapeutics is seeking a Physician Clinical Reviewer - Pediatric Gastroenterology for a remote position. The ideal candidate will have a DO, MBBS, or MD degree and 5+ years of clinical experience. The role involves reviewing service requests, interacting with physicians and leadership staff, and providing clinical rationale for appeals.
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.
- Provides assistance and acts as a resource to Initial Clinical Reviewers.
- Ensures documentation of all communications with medical office staff and/or physician/provider is recorded in a timely and accurate manner.
- 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
- Employee Assistance Program
- Tuition Reimbursement
- Health Insurance
- Dental Insurance
- Vision Insurance
- Life Insurance
- Disability Insurance
- Flexible Spending Account
- Employee Stock Purchase Plan
